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Intent to Enroll Form
 Please complete one form for each child you intend to enroll at RVS

This Intent to Enroll is used to initiate pre-enrollment for the Riverside Virtual School (RVS).  Parents of students that desire to attend RVS, in a full-time capacity, are encouraged to submit the Intent to Enroll as soon as possible.  Please be advised that completion of this form does not obligate the student to attend Riverside Virtual School, nor does it serve to guarantee admission at this time.

Riverside Virtual School is a tuition-free public school, established by action of the Riverside Unified School District. Fall enrollment is open for students that will be in grades 6-12, who desire to receive a college preparatory education. Parents desiring enrollment during the 2009-2010 school year are encourages to complete the form and/or make contact with the school office for information.

Any personal information submitted will remain confidential.  All parents and students will be required to attend a pre-enrollment meeting prior to the school’s opening to complete additional paperwork.

If you have specific questions, please e-mail these to the attention of Judy Dunbar, Principal's Secretary.

I am interested in having my child attend Riverside Virtual School.  I am aware that this form will serve as a demonstration of my intent to enroll my child as a full-time student in the fall of 2009.  Submission of this form does not guarantee my child’s enrollment in this school, nor does it legally bind me to enroll my child.

Please Note: Fields marked with an "*" are required fields

STUDENT INFORMATION

*Child's First Name:

 Enter first name

*Child's Last Name:

Enter last name

*Child's Birth Date: (mm/dd/yyyy)

 A value is required.Invalid format.

*My child will enter the following grade in the 2009-2010 academic school year.

 Select a valid item.


*Identify the school district your child currently attends: Enter district.

*Does the student attend an RUSD school on an Inter-district Transfer from another school district? Select a valid item.

If "Yes", please identify the school district and school for your residential area.

Please mark any of the following special programs through which your child receives services:

Gifted and Talented (GATE)

English Learner Services (child is an identified English language learner)

Special Education (child has an established Individual Education Plan)

Child is physically handicapped

Child is in Home-Hospital care

Child is currently home schooled

Other: Please describe

Special Comments: Please let us know if you have any specific needs or concerns that are not addressed on the form.

Language

*Please indentify the primary language spoken in the home: Select a valid item.     

Other: (please specify)

PARENT/GUARDIAN INFORMATION

Primary Contact:

*First Name:

 Enter first name

*Last Name:

 Enter last name

*Home Address:

Enter address

*City:

 Enter city

*Zip:

Enter 5 digit .Enter 5 digit zip code

*Home Phone:

 A value is required.Invalid format
(xxx) xxx-xxxx

*Work/Cell Phone:

 A value is required.Invalid format
(xxx) xxx-xxxx

Email Address:

Secondary Contact:

*First Name:

 Enter first name

*Last Name:

 Enter last name

*Home Address:

Enter address

*City:

 Enter city

*Zip:

A value is required.Enter 5 digit zip code

*Home Phone:

 A value is required.Invalid format.
(xxx) xxx-xxxx

*Work/Cell Phone:

 A value is required.Invalid format.
(xxx) xxx-xxxx

Email Address:

Please review form prior to clicking below. Once the form is received, you will be contacted by the school with information regarding parent information meetings. Attendance at a parent information meeting is required of all potential enrollees and their parents.