Registration Form

Registration
Welcome to Tri-Valley!

Please allow yourself enough time to complete the registration form in one sitting. Once started you will not be able to save and return to the packet at a later time.

The form should take approximately 15-30 minutes to complete. If you have more than one child you will need to complete a separate form for each child based on their grade level.

Submission of this completed registration form does not guarantee your child’s enrollment in school. You must also provide the following required documentation to the district’s registrar:
- Your Child’s Original Birth Certificate (or certified copy) or other satisfactory proof of age
- Custody Papers (if applicable)
- Parent/Guardian’s Photo ID
- Two Proofs of Residency (deed, lease, utility bill, driver’s license or other photo identification card with address, voter registration, income tax return, current paycheck with address on it, affidavit, third party statement, or government issued document)
- Any other information regarding your child, such as a recent report card, IEP, testing results, etc.
- Recent Physician’s Physical (form included in General Registration Packet)
- Recent Dental Health Certificate (form included in General Registration Packet)
- Immunization Record signed by physician
Upon submission, this form will be sent directly to the District’s Registrar. If you have any questions regarding registration please feel free to contact the Registrar by phone at (845) 985-2296 ext 5405 or email registration@trivalleycsd.org.

Thank you!

Other Household Members

List all the people living in the same household as the child.
Name

First NameLast Name
Age
(if child)
Grade
(if child)
Gender
Relationship to Child
I have additional household members to add.
Name

First NameLast Name
Age
(if child)
Grade
(if child)
Gender
Relationship to Child
I have additional household members to add.
Name

First NameLast Name
Age
(if child)
Grade
(if child)
Gender
Relationship to Child
I have additional household members to add.
Name

First NameLast Name
Age
(if child)
Grade
(if child)
Gender
Relationship to Child
I have additional household members to add.
Name

First NameLast Name
Age
(if child)
Grade
(if child)
Gender
Relationship to Child

Request for Records
Student Name*

First NameLast Name
Grade*
Date of Birth*

MonthDayYear
has enrolled in the Tri-Valley Central School District. Please forward copies of the information listed to the address(es) below:
- academic records
- birth certificate
- immunization records
- attendance records
- standardized testing
- health and dental records
Tri-Valley Central School
Registration Office
34 Moore Hill Road Grahamsville,
NY 12740
Phone: (845) 985-2296 x 5405
Email: registration@trivalleycsd.org

Psychological evaluations and special education recommendations (if any), should be sent to the address below:

Tri-Valley Pupil Personnel Services
34 Moore Hill Road
Grahamsville, NY 12740
(845) 985-2296 x 5308
Fax: (845) 985-2481
Date*

MonthDayYear
YesNo
School Name:
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fax Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
YesNo
Physician Name
Fax Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Signature

Clear
Tri-Valley Central School District Registrar
Date

MonthDayYear
(Parent permission is no longer required when records are requested by authorized school personnel. (Family Educational Rights and Privacy Act, Final Rule on Education Records, Federal Register, June 17, 1976, Vol. 41, NO> 118, page 24673)

New York State Migrant Education Program

Education & Recruitment Office Parent Survey
The Migrant Education Program (MEP) is authorized by Title I, Part C of the Every Student Succeeds Act (ESSA). The MEP provides a variety of educational services to families who work in agriculture, regardless of their nationality or legal status. This program is Free of charge to all eligible families and may include tutoring, free lunch eligibility, educational field trips, summer programs, parent involvement activities, emergency needs and referrals to other services as needed.

Please take a few minutes to complete this questionnaire.

Have you or has someone in your family worked on a farm?

Have you moved during the past 3 years?
Any agricultural, farm, or fishing work (such as hay, dairy, fruit or vegetable crops, poultry, fishing, nursery/greenhouse, etc.)Work related to logging, harvesting, or initial processing of trees.Work at food processing plant, (such as meat or poultry processing plants, packing fruits or vegetables, etc.)
Parent/Guardian Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Best time to be reached

Hour Minutes

AM/PM Option
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Name

First NameLast Name
Age
Grade
YesNo
Student Name

First NameLast Name
Age
Grade

Photo & Video Opt Out Form
Complete this form if you do NOT give permission for your student’s image to appear in school publications, including postings on the Tri-Valley CSD website.

From time to time, photographs or videos of students are taken during the school day for use in District and educational news releases, publications, video productions, social media, educational projects, and the District website.

If you do NOT wish to have your child photographed/videotaped for news media or school publicity purposes, sign and return this form to your school building principal. Parents must submit this form to their student’s Principal by September 15 of each year or at the time of registration to the District. This form applies only to the current school year and must be filled out each year if you do not want your child’s image published.
Student's Name

First NameLast Name
School Year
Grade
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Please note that if your student participates in public events (such as a sporting event or drama production that is open to the community) the school/district may have little or no control over photographs taken by media, other parents, or community members attending the event.

Students 18 years of age do not require parental consent for photo use. For more information, contact the District Office at (845) 985-2296.
Should be Empty:

Registration

Student Registration

For Office Use Only

Transportation Information

Legal Custody Information

Parent/Guardian Information

Other Household Members

Emergency Contacts

Student Background

Request for Records

Home Language Questionnaire (HLQ)

New York State Migrant Education Program

Photo & Video Opt Out Form