Pleasant Valley
Community Schools
Kindergarten Inquiry Form

If you would like to begin the enrollment process for Kindergarten, please complete and submit the following form. Your information will be added to our contact lists and you will receive additional information when registration opens for the upcoming school year in February.

Child's First Name: *

Child's Last Name: *

Child's Birthdate: *

Child’s Gender:*

School Your Child Will Be Attending In Kindergarten:*

Parent's First Name: *

Parent's Last Name: *

Parent's Phone Number: *

Parent's E-mail Address: *

Address: *

City: *

State: *

Zip: *

Mailing Address (If Different From Above):

Additional Comments:

Administration Center

525 Belmont Road
Bettendorf, IA 52722

Phone: (563) 332-5550
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