BTE 21st CENTURY DISCOVERY INSTITUTE (Enrollment Form)

BTE 21st CENTURY DISCOVERY INSTITUTE

Student Enrollment Form
Additional Documents for Registration

Complete this registration form by May 31st to be considered for admission.

In additon to this form, you will need:

Copy of Student's Birth Certificate
Current Immunization Form
Copy of any IEP or 504 Documentation
Declaration of Intent (only for students choosing to CO-OP)

Tuition Agreement (Provided after student acceptance)
Medical Release Agreement (Provided after student acceptance)
Media Release Agreement (Provided after student acceptance)
Technology Use Agreement (Provided after student acceptance)
Field Trip Experience Agreement (Provided after student acceptance)
Zoned School District:
Grade Entering:
Student Information
Are you applying for enrollment as a Full Day or CO-OP student?

Full Day Homeschool CO-Op Virtual Full Day Hybrid (2 days)
Name

First Name Last Name
Preferred Name
With whom does the student reside?

Mother Father Both Parents Legal Guardian
Birth Date:

Month Day Year
Date
Age:
Gender:
Address

Address

Street Address Line 2

City

Zip
Does your child have a 504 plan or an IEP
Does your child require any medications to be administered while at school?
Parent/Guardian Contact Information
Name of Parent/Guardian
Parent Email Address
example@example.com
Contact Number

Area Code Phone Number
Emergency Contacts (Please lists adults authorized to check out student from school)
Name of Authorized Person
Home No.
Cell No.
When a parent/guardian enrolls a student at BTE 21st Century Discovery Institute the student is REQUIRED to stay at Discovery Institute for at least a semester. Requests to change the placement from Discovery Institute back to the zoned school after the semester has begun will not be honored. I understand and agree to this attendance requirement
IMPORTANT
Parent/Legal Guardian Signature

Clear
Date

Month Day Year
Date
Should be Empty:

BTE 21st CENTURY DISCOVERY INSTITUTE

Student Information

Parent/Guardian Contact Information

IMPORTANT