Student Application

About Your Child
Does your child have

Individualized Education Plan (IEP) 504 plan for accommodations No identified needs but I have concerns Undergoing evaluation/assessment at this time Regular Education and no concerns at this time
Please tell us about your child's interests/hobbies and how they prefer to spend their free time. *
What motivates your child? *
How does your child learn best (visuals/watching, listening/time to think, hands-on activities, or any combination)? *
Does your child have any specific fears or worries that we should know about? *
What will your child do when anxious, stressed or upset? *
What strategies work for helping your child to re-focus and move past stressful, anxious or upsetting events? *
Do you have any academic or social/emotional concerns about your child? If so please elaborate. *
What are your goals for your child at BTB? *
Is there anything else you would like us to know about your child?

Emergency Contact 1
Name

First Name Last Name
Phone Number

Area Code Phone Number
Emergency Contact 2
Name

First Name Last Name
Phone Number

Area Code Phone Number
Physician and Medical Information
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Preferred Hospital *
Insurance/Health Coverage (Company) *
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns. *

City
State

Massachusetts Rhode Island Other
Notes
Please inform the us of any other vital information you think they may need to know in the event of an emergency. Thank you.

Tutoring, Electives and Beyond

Full list of after school options can be found here: https://beyondthebelleducation.com/academic-electives.html
I want to sign my child up for the following *

Academic Tutoring (math, reading, writing) Dyslexia remediation/tutoring Social Skills Group Electives After school (Best of The Bell)
Please indicate what you are looking for. Our full list of after school electives can be found on our website. Electives will be offered on a rotating basis with rolling admission. Academic tutoring will be available daily between 4-6 pm by appointment only.
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After school at BTB