Student Information NOTE: Items in red are required and must be filled in.

 Male  Female

Use 2 character abbreviation.
Use 5 or 9 digit ZIP code.
Use 999-999-9999 format.
Emergency Contacts Use 999-999-9999 format.
Use 999-999-9999 format.
Use 999-999-9999 format.

 Both Parents Biological Father Biological Mother Guardian Other

Must be a valid email address.
Education History

Lillian Vallely School is a private, non-profit Christian-based school that relies solely upon various grants, donations and other forms of financial support to facilitate its mission. Although we do not charge tuition, we anticipate parents/guardians will willingly give of their time, talent and/or treasure to insure their child’s education occurs in a safe, wholesome learning environment. Volunteering your time and/or talent also provides a meaningful affirmation to your child of the importance of both community and the value of education, two of Lillian Vallely School’s primary objectives. Please consider the following opportunities and indicate those areas you would assist Lillian Vallely School.

Applications are not considered complete until all requested materials and former school records are received. Lillian Vallely School reserves the right to deny admission to any student whose presence is deemed contrary to the school’s best interest.

By checking the checkboxes beside each statement below, you are agreeing to the terms of those statements. If you do not agree to all of those statements, you may not submit this application for enrollment at Lillian Vallely School.
  I hereby attest that the information provided above is true and correct to the best of my knowledge. I also acknowledge my responsibility for this child’s education and will encourage him/her to excel through consistent attendance, by volunteering my time, talent(s) and/or financial support, and through my regular communication with the school and/or staff including attendance at parent – teacher conferences throughout the year.

 When supporters of Lillian Vallely School view our website, annual report, newsletter and/or other publications and media forms, the presence of the school’s visual image, its staff and students, combined with photos/videos of our activities, encourages support and financial contributions. Therefore, I agree to allow my child’s photograph/likeness/ image to appear in promotional materials, reports, newsletters and all other forms of media, provided that my child’s name does not appear in said material, report, newsletter or other media form

 I hereby consent to the release of all educational records for to be released to Lillian Vallely School, P.O.Box 790, Blackfoot, ID 83221.