2019-2020 Learning Center Enrollment Documents

Welcome to our Learning Center, 

Below you will find the individual links for the Brookhaven Learning Center Enrollment Documents needed. 

Reminder: Effective June 21, 2019, admission/enrollment packets and agreements outlining the services and costs associated with services for students provided by Brookhaven Treatment and Learning Center must be signed prior to the student’s determined start date. If contracts are not signed by the LEA at this time and/or paperwork required by parent(s)/guardians(s) are not complete, services will not be provided, and the student cannot attend until admission packets and contract paperwork is complete and on file at Brookhaven.

At this time, the start date is considered to be August 27, 2019, the first day of school. If paperwork is not completed by August 26, 2019, your student(s) will not be able to attend school until complete. 

Thank you for your understanding.

Please let us know if you have any questions or need  assistance with any of the paperwork. 

Thank you.

Brookhaven Learning Center

Contact: Ashley Grote

Form	Completed by/Notes
Client Information Form	Parent/Guardian
Brookhaven Student Health Form	Parent/Guardian
Consent for Time Out and Physical Interventions	Parent/Guardian
Learning Center Consent to Act as Emergency Care Agent	Parent/Guardian
Release of Information Form	Parent/Guardian /Sending School: (1 for each provider)
Authorization to Dispense Prescription Medication	Parent/Guardian & Prescribing Physician (if applicable) (must be completed, even if student does not take medication during the school day)
Consent for Photograph	Parent/Guardian
Handbook and Policy Acknowledgement	Parent/Guardian
School-to-Home CommunicationÂ	Parent/Guardian
Bullying Policy and Disciplinary Protocol	Parent/Guardian
Individual Crisis Management Plan (Initial Intake)	Parent/Guardian
Immunization Records	Physician (Contact student’s physician to have records faxed to (802) 685-3094 Attention: Ashley Grote)
Technology Acceptable Use Form	Parent/Guardian/Student
FERPA Disclosure and Acknowledgement	Parent/Guardian
Learning Center Treatment Consent Form	Parent/Guardian Placing Agency
Activity Release Form	Parent/Guardian

Thank you for your interest in Brookhaven Treatment and Learning Center! Your contribution to Brookhaven can make a difference today and in the future for some of our challenged young people.