Silver Valley Adult School Registration

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Please complete all required fields to register for Silver Valley Adult School. If you have any questions, issues, or concerns, please contact Silver Valley Adult School at (760) 254-2715.

Email *

Enrollment Year *

2023 - 2024 School Year

First Name *

Middle Name

Last Name *

Maiden Name (if applicable)

Date of Birth *

YYYY

Gender *

Male

Female

Non-Binary

Phone Number *

Secondary Phone Number *

Emergency Contact Information (Name, Relationship, Phone Number) *

Address Line 1 (street number and name) *

Address Line 2 (if applicable)

City *

State *

Zip Code *

Mailing Address (if different from physical address)

Primary Language Spoken *

Native Language *

Ethnicity: Do you consider yourself to be of Hispanic/Latino origin? *

Yes

What is your race? (select one or more) *

African American/Black

American Indian/Alaskan

Asian Indian

Cambodian

Chinese

Filipino

Guamanian

Hispanic/Latino

Hmong

Japanese

Korean

Laotian

Native Hawaiian

Other Asian

Other Pacific Islander

Samoan

Tahitian

Vietnamese

White

Required

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