Registration for the 2021-2022 School Year

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Terms of Use* This field is required.Please review the Terms of Use and click "I agree" to continue. Please read this document and make sure you understand it. It explains our commitment to protecting the privacy and security of the information gathered by Shanél Valley Academy’s (“SVA”) online registration system, how the information is used, and with whom the information is shared. NOTICE: By continuing to use this system you will be deemed to have accepted these Terms of Use. Maintaining the privacy of your family's personal information is at the core of our business. We are committed to taking appropriate measures to maintain the privacy of the information you submit to us. We will not sell or rent your information to anyone, or let anyone use it except if you have authorized its use. We are especially sensitive to the need to protect information concerning children. Protecting the identity and privacy of children is an important undertaking and a high priority for SVA. Only those SVA employees, consultants, or Board Members who need the information you have provided to the database to perform their job responsibilities are authorized to have access to your stored information. We at SVA understand that the information you store in the online registration database is of the highest value to you and must be secure at all times. We protect your information when it is received by and sent from our database by encrypting the data. In addition to the system architecture and network design features in place, we also control physical access to your information. Access to the system is a privilege, not a right. Intentional misuse or alteration of the student record that is intentionally false or inaccurate could lead to your account termination without notice. SVA monitors its network and systems for signs of unauthorized access. We have taken care to provide a high degree of security, but there is no perfect system either online or offline. If you suspect any violation of security on this system, please immediately notify us at info@shanelvalleyacademy.com. All matters referred to us will be promptly investigated.
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Student's Name
Student's Legal First Name
Student's Legal Last Name
Student's Legal Middle Name
Jr.
Sr.
I
II
III
IV
V
Student's Suffix
Student's nick name (optional)
Male
Female
Nonbinary
Student's Gender
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Student Address
Street Address
Street Address 2
City
State
Zip Code
Student's Home Phone Number
Yes
Yes
No, use a different address for mail.
Use residence address above as mailing address
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Student's Other Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Student Birthdate* This field is required.Please enter the student's birthdate.
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Grade Entering* This field is required.Kindergartners must be 5 years old by September 1st, 2022 in order to be eligible for Kindergarten. Students who turn 5 years old between September 2nd, 2022 and June 30th, 2023 are eligible to enroll in Transitional Kindergarten. All new enrollees must have current immunizations as required by law. Public schools no longer accept immunization exemptions based on personal beliefs for children.
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Is this student Latino or Hispanic?* This field is required.The following questions are required by federal law. (A two-part question must be used to collect data about students’ race and ethnicity. The U.S. Department of Education (ED) requires these standards for federal education eligibility and accountability reports. The California Department of Education (CDE) is also requiring local educational agencies (LEAs) and schools to collect and report data consistent with these federal requirements.)
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What is the race of this student? You may select up to five.* This field is required.The following questions are required by federal law. (A two-part question must be used to collect data about students’ race and ethnicity. The U.S. Department of Education (ED) requires these standards for federal education eligibility and accountability reports. The California Department of Education (CDE) is also requiring local educational agencies (LEAs) and schools to collect and report data consistent with these federal requirements.)
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Language Information* This field is required.The California Education Code requires schools to determine the language or languages spoken at home by each student. Please answer the following questions by selecting the appropriate language.
English
Spanish
Mandarin
Chinese
Arabic
German
French
Native American
Other
What language did your child learn when he/she first began to talk?
English
Spanish
Mandarin
Chinese
Arabic
German
French
Native American
Other
Which language does your child most frequently speak at home?
English
Spanish
Mandarin
Chinese
Arabic
German
French
Native American
Other
Which language do you (the parents or guardians) most frequently use when speaking with your child?
English
Spanish
Mandarin
Chinese
Arabic
German
French
Native American
Other
Which language is most often spoken by adults in the home? (parents, guardians, grandparents, or any other adults?)
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Parent/Guardian Information #1* This field is required.Please provide information about parents/guardians who live with the student. Information about parents/guardians who do not live with the student will the collected in the next step.
First Name
Last Name
Select Relationship
Mother
Father
Step-Mother
Step-Father
Foster Mother
Foster Father
Guardian
Brother
Sister
Aunt
Uncle
Grandmother
Grandfather
Court-Appointed Guardian
Family Friend
Social Worker
Relationship to Student
Yes
No
Allow Access to Parent Portal
Yes
No
Does this parent/guardian live with the student?
Phone Number
Email Address
Select Education Level
Not High School Graduate
High School Graduate
Some College (Includes AA Degree)
College Graduate
Grad School / Post Grad School
What is the highest parent level of education?
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Should a second copy of mail be sent to this contact?* This field is required.Mail will be sent to the student's home address, however a second copy of mail can be sent to an additional address.
YESNO
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Parent/Guardian #1 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Parent/Guardian Information #2Please provide information about parents/guardians who live with the student. Information about parents/guardians who do not live with the student will the collected in the next step.
First Name
Last Name
Select Relationship
Mother
Father
Step-Mother
Step-Father
Foster Mother
Foster Father
Guardian
Brother
Sister
Aunt
Uncle
Grandmother
Grandfather
Court-Appointed Guardian
Family Friend
Social Worker
Relationship to Student
Yes
No
Allow Access to Parent Portal
Yes
No
Does this parent/guardian live with the student?
Phone Number
Email Address
Select Education Level
Not High School Graduate
High School Graduate
Some College (Includes AA Degree)
College Graduate
Grad School / Post Grad School
What is the highest parent level of education?
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Should a second copy of mail be sent to this contact?Mail will be sent to the student's home address, however a second copy of mail can be sent to an additional address.
YESNO
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Parent/Guardian #2 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Restrained IndividualIs there an individual who is restrained from contact with this student by court decree?
No, there is not an individual restrained by court decree
Yes, an individual is restrained by court decree
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Restrained Individual's InformationPlease provide information about parents/guardians who live with the student. Information about parents/guardians who do not live with the student will the collected in the next step.
First Name
Last Name
Mother
Father
Step-Mother
Step-Father
Foster Mother
Foster Father
Guardian
Brother
Sister
Aunt
Uncle
Grandmother
Grandfather
Court-Appointed Guardian
Family Friend
Social Worker
Other
Relationship to Student
Phone Number
Address
City
State
Employeer
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Emergency Contacts #1* This field is required.Please provide at least two emergency contacts and up to four emergency contacts other than the parent/guardian entered on the previous screens.
First Name
Last Name
Select Relationship
Mother
Father
Step-Mother
Step-Father
Foster Mother
Foster Father
Guardian
Brother
Sister
Aunt
Uncle
Grandmother
Grandfather
Court-Appointed Guardian
Family Friend
Social Worker
Relationship to Student
Primary Phone Number
Employer
Employer Phone Number
Yes
No
Allow Access to Parent Portal
Yes
No
Allow for Student Pickup
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Emergency Contacts #2* This field is required.Please provide at least two emergency contacts and up to four emergency contacts other than the parent/guardian entered on the previous screens.
First Name
Last Name
Select Relationship
Mother
Father
Step-Mother
Step-Father
Foster Mother
Foster Father
Guardian
Brother
Sister
Aunt
Uncle
Grandmother
Grandfather
Court-Appointed Guardian
Family Friend
Social Worker
Relationship to Student
Primary Phone Number
Employer
Employer Phone Number
Yes
No
Allow Access to Parent Portal
Yes
No
Allow for Student Pickup
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Emergency Contacts #3Please provide at least two emergency contacts and up to four emergency contacts other than the parent/guardian entered on the previous screens.
First Name
Last Name
Select Relationship
Mother
Father
Step-Mother
Step-Father
Foster Mother
Foster Father
Guardian
Brother
Sister
Aunt
Uncle
Grandmother
Grandfather
Court-Appointed Guardian
Family Friend
Social Worker
Relationship to Student
Primary Phone Number
Employer
Employer Phone Number
Yes
No
Allow Access to Parent Portal
Yes
No
Allow for Student Pickup
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Emergency Contacts #4Please provide at least two emergency contacts and up to four emergency contacts other than the parent/guardian entered on the previous screens.
First Name
Last Name
Select Relationship
Mother
Father
Step-Mother
Step-Father
Foster Mother
Foster Father
Guardian
Brother
Sister
Aunt
Uncle
Grandmother
Grandfather
Court-Appointed Guardian
Family Friend
Social Worker
Relationship to Student
Primary Phone Number
Employer
Employer Phone Number
Yes
No
Allow Access to Parent Portal
Yes
No
Allow for Student Pickup
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Health Survey* This field is required.Please provide a list of any medical conditions this student has by selecting a medical condition from the drop down selection. You may provide additional information about the condition in the comment area.
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Other School Enrollment Information* This field is required.Has this student previously attended a TK-6 school in California?
No, this student has not attended a school in California.
Yes, this student has attended a school in California.
This student has previously attended school in another state or country.
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Previous School InformationIf this student has previously attended school for grade TK - 6 in another district or school, please provide as much information as possible.
District Name
School Name
City
State
Transitional Kindergarten
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
Select Last Grade Attended
No
Yes
Was this student expelled?
No
Yes
Was this student in special education?
No
Yes
Was this student on a 504 plan?
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Supplemental Questions* This field is required.Please respond to the questions below.
Single-family permanent residence (house, condo, mobile home, apartment etc.)
Temporary Shelter or Transitional Housing
Hotel/Motel
Temporarily Double/Tripled Up
Unsheltered (car, campsite, etc.)
Where is your student currently living?
Yes
No
Did your student attend preschool?
No
Yes
Does your student live on tribal, trust, or federal land?
English
Spanish
Preferred language for school correspondence
United States
Other
Where was your student born?
No, this student does not have a parent/guardian who is active in the United States Armed Forces.
Yes, at least one parent/guardian of this student is active in the United States Armed Forces.
Family Military Survey
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Household Income Data Collection - Part 1* This field is required.SVA must collect alternative income information from each household to be counted as eligible for free or reduced-priced meals. The information submitted on this form is a confidential educational record and is therefore protected by all relevant federal and state privacy laws that pertain to educational records.
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Household Income Data Collection - Part 2* This field is required.SVA must collect alternative income information from each household to be counted as eligible for free or reduced-priced meals. The information submitted on this form is a confidential educational record and is therefore protected by all relevant federal and state privacy laws that pertain to educational records.
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As a parent/guardian, I would need after school care.* This field is required.*After school care is free for all students to attend. The program will operate until 6:00pm. This question helps us evaluate staffing.
YESNO
29
As a parent/guardian, I understand that SVA will not provide transportation to and from school.* This field is required.
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Required Documents* This field is required.Below is a list of documents that MUST be submitted to the SVA front office prior to August 15, 2022. 1. Signed Parent/Student Handbook (Page 17) 2. Additional documents if applicable: a. Student's Health Insurance Card b. Authorized Health Care Provider Request for Medication (Medication if your child will have any type of medication at school.)
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Required Documents (TK/Kindergarten)* This field is required.Below is a list of documents that MUST be submitted to the SVA front office prior to August 15, 2022. 1. Signed Parent/Student Handbook (Page 17) 2. Verification of age (copy of birth certificate, baptism certificate, passport, etc.) 3. Students Immunization Record (Proof of Immunization Records are required of all entering students. Public schools may no longer accept immunization exemptions based on personal beliefs for children.) 4. Report of Health Examination for School Entry (TK, K, only) 5. Oral Health Examination for School Entry (TK, K, only) 6. Additional documents if applicable: a. Student's Health Insurance Card (If Needed) b. Authorized Health Care Provider Request for Medication (Medication if your child will have any type of medication at school.)
32
Parent / Student Handbook Read, sign, and return page 17 to the front office.
33
Medical Evaluation Form (Download for Future Use)To protect the health of children, California law requires a health examination on school entry. Please have this report filled out by a medical professional and return it to the school. The school will keep and maintain it as confidential information.
34
Oral Health Evaluation Form (Download for Future Use) California law (Education Code Section 49452.8) states your child must have a dental check-up by the first year in public school.
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Required Immunizations (Download) These immunization requirements apply to new admissions and transfers for all grades, including transitional kindergarten.
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Comments
37
Parent/Guardian Signature* This field is required.Once the student enrollment form is submitted, the student is deemed enrolled. Admissions includes the submitting of appropriate required documentation. An enrolled student will be removed from the School if failure to comply with these admissions procedures is discovered after enrollment has been granted. The information submitted on this form is a confidential educational record and is therefore protected by all relevant federal and state privacy laws that pertain to educational records including, without limitation, the Family Educational Rights and Privacy Act of 1974 (FERPA), as amended (20 U.S.C. § 1232g; 34 CFR Part 99); Title 2, Division 4, Part 27, Chapter 6.5 of the California Education Code, beginning at Section 49060 et seq.; the California Information Practices Act (California Civil Code Section 1798 et seq.) and Article 1, Section 1 of the California Constitution.
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