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.
Brookhaven Learning Center
Contact: Ashley Grote
|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|
(1 for each
|Authorization to Dispense Prescription Medication||Parent/Guardian & Prescribing Physician (if applicable)|
(must be completed,
even if student
does not take
during the school
|Consent for Photograph||Parent/Guardian|
|Handbook and Policy Acknowledgement||Parent/Guardian|
|Bullying Policy and Disciplinary Protocol||Parent/Guardian|
|Individual Crisis Management Plan (Initial Intake)||Parent/Guardian|
physician to have
records faxed to
|Technology Acceptable Use Form||Parent/Guardian/Student|
|FERPA Disclosure and Acknowledgement||Parent/Guardian|
|Learning Center Treatment Consent Form||Parent/Guardian|
|Activity Release Form||Parent/Guardian|