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

FormCompleted by/Notes
Client Information FormParent/Guardian
Brookhaven Student Health FormParent/Guardian
Consent for Time Out and Physical InterventionsParent/Guardian
Learning Center Consent to Act as Emergency Care AgentParent/Guardian
Release of Information Form
/Sending School:

(1 for each
Authorization to Dispense Prescription MedicationParent/Guardian & Prescribing Physician (if applicable)
(must be completed,
even if student
does not take
during the school
Consent for PhotographParent/Guardian
Handbook and Policy AcknowledgementParent/Guardian
School-to-Home Communication Parent/Guardian
Bullying Policy and Disciplinary ProtocolParent/Guardian
Individual Crisis Management Plan (Initial Intake)Parent/Guardian
Immunization RecordsPhysician
(Contact student’s
physician to have
records faxed to
(802) 685-3094
Ashley Grote)
Technology Acceptable Use FormParent/Guardian/Student
FERPA Disclosure and AcknowledgementParent/Guardian
Learning Center Treatment Consent FormParent/Guardian
Placing Agency
Activity Release FormParent/Guardian