Clayton Valley Charter High School Enrollment and Authorization to Release Information
Dear current and prospective Clayton Valley Charter High School parents/guardians: By signing and returning this form, you are indicating your intent to enroll your child in the Charter School’s classroom-based program during the 2012-13 school year. Forms are due back to the CVHS office by February 24, 2012.
Student Information:
Name: _____________________________________________________ Last, First, Middle
Grade in 2012-13: ____________
Home Address: ____________________________________________________MDUSD Student #__________ Street City State Zip Home Phone: ______________________Age: ________ Date of Birth: ___________________ Current Clayton Valley High School student? Y / N (circle one) If no, please list the school your son/daughter currently attends_____________________________________ Resident of current Clayton Valley attendance area? Y / N (circle one)
Do you have a sibling at Clayton Valley High School? Y / N (circle one) ___________________________________________________________________________________________ Parent/Legal Guardian Name: _____________________________________________________________________________ Last, First Middle Home Address: _____________________________________________________________________________ Street City State Zip Home Phone: ______________________
Email: _____________________________________
By signing below, I am indicating that
1. 2. 3.
I intend to enroll the above named child in Clayton Valley Charter High School for the 2012-13 school year. I understand that the enrollment process is not complete until a full registration packet is completed and returned by April 19, 2012. Failure to return this packet by the date indicated may result in a forfeiture of your space. I authorize the MDUSD to release all records in my student’s cumulative file to the official representatives of the CVCHS. Records will not be released until my student is officially enrolled for the 2012-2013 school year.
Signature of Parent/Legal Guardian: _________________________________________________ Date:______________________ IMPORTANT!! Return in person, by mail, or by fax to: 1101 Alberta Way, Concord, CA 94521 Fax: 925-825-7859