Student Information:
Vine Haven Adventist School does not discriminate on the basis of race, color, religion, national or ethnic origin, gender, or disability in the administration of its educational program, admission policies, and other school-administered programs.
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Applicant’s Full Name: *
(First, Middle, Last)
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Gender: *
Social Security Number: *
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Home Address: *
(Number & Street City, State & Zip Code)
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Home Telephone:
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Age: *
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Date of Birth: *
Place of Birth: *
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U.S Citizen: *
Ethnic Background: *
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Primary Language spoken at home: *
Do you have student’s proof of birth? *
(If yes, please submit copy to Registrar)
Clothing Sizes: Top / Bottom *
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