Bridges Preparatory Academy

Bridges Preparatory Academy

Enrollment Registration
schoolId
Parent_relationship
preferred_contact
source
language
leadid
Year for enrollment?*
How did you hear about us?*
Please specify*

Parent/Guardian Information

(Must be listed on birth certificate or legal custody document)
Check one:*

MotherStepmotherFatherStepfatherGuardianFosterOther
Resides/Lives with student*

YesNo
Parent / Guardian Full Name*

First NameMiddle NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email *
example@example.com
Education Level*
Parent / Guardian #2 Full Name

First NameMiddle NameLast Name
Home Address #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone #2
Please enter a valid phone number.
Cell Phone #2
Please enter a valid phone number.
Work Phone #2
Please enter a valid phone number.
Email #2
example@example.com
Education Level

Household Information

Siblings in the household (if any):

	Grade	Current School
Child 1 Name:
Child 2 Name:
Child 3 Name:
Child 4 Name:

What language did your child learn to speak first?*
What language does your child most frequently use at home?*
What language do you most frequently use to speak to your child?*
What language do the adults in the home speak most frequently amongst themselves?*
Do you have Internet in your home?*

Emergency Contacts

Other persons authorized to pick up your child, must be 18 years of age or older

	Name	Relationship to Student	Phone Number	Email Address
Contact 1
Contact 2
Contact 3

Medication Authorization Form
Name of Child*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Does your child take any medication?*
California Ed Code 49423 allows the school nurse or other designated school personnel to assist students who are required to take medication during the school day. This service is provided to enable the student to remain in school or maintain or improve the potential for education and learning.

Medication must be in the container in which it was purchased with a pharmacy label attached. No medication (including over-the counter medication and supplements) will be given at school without a current prescription from a California licensed physician.
Physician's Order (To be completed by health care provider) Only one medication per form.
Name of medication/strength of tablet, capsule or liquid:*
This medication is a controlled substance*
Dosage:*
How often?*
Time to be given at school:*

Hour Minutes

AM/PM Option
Route to be given:*
Reason for medication/Diagnosis:*
Possible side effects:*
Has the student been instructed by a physician in self-administration and may carry an inhaler with them?*
Has the student been instructed by a physician in self-administration and may carry an Epi-Pen with them?*
Name of Licensed Physician*

First NameLast Name
Signature of Licensed Physician (if available)

Clear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date*

MonthDayYear
Date
License #*
I request that my child be assisted in taking the above prescrived medication at school by authorized persons. I will comply with the school's policies and procedures. I will notify the school if there arechanges in my child's health status, changes in medication or change in health care provider.

I authorize exchange of information between my child's Physician and school site administrator with regard to this medication request.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Phone Number (Home)*
Please enter a valid phone number.
Phone Number (Emergency)*
Please enter a valid phone number.

Release of Information
I hereby authorize Bridges Preparatory Academy to shar and/or request any and all records, data or information determined to be relevant to the education of my child with the Compton Unified School District, the California Department of Education, any other schools and school systems in which my child has previously been enrolled, and any governmental departments, health or social service providers, or other offices whose activities bear directly on the programs or services with which my child is provided at Bridges Preparatory Academy. I understand that all such information will be kept strictly confidential.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Military Connected Family: In efforts to provide resources and support to military connected students and their families, please respond to the following:
Do you have an immediate family member in the military?*
Status:*

ActiveGuardReserveVeteranDeceased
Military Branch:*
Are they currently deployed?*
Student's First Day of School in the U.S.:*

MonthDayYear
Date
Student's First Day of School in California*

MonthDayYear
Date
U.S. Arrival Date, if recently arrived (last 3 years):

MonthDayYear
Date
Affidavit

By signing this form, I declare under the penalty of the laws in the state of California that the foregoing is true and correct. In addition, I understand that the District reserves the right to verify the above listed residence information.
Signature of Parent/Legal Guardian/Caregiver:*

Clear
Date*

MonthDayYear
Date
Throughout the rigorous academies and character development, Bridges Preparatory Academy prepares all 6th through 8th grade students to succeed within the high school and college of their choice and to be positive, engaged members of their communities.

Title 1

School-Parent Master Agreement
In an effort to build and develop a strong and responsible partnership that will help Title 1 achieve the State of California's high academic standards, the following is agreed upon.

As a student, I will be responsible for...
1. Coming to class on time and being prepared to work.
2. Respecting the rights of others to learn without distraction and disruption.
3. Showing respect and cooperating with all adults in the school.
4. Completing all assignments to the best of my ability.
5. Showing respect for people and property by not using profanity, stealing, or vandalizing.
6. Obeying campus rules.
7. Spending time at home studying and reading daily.
Student Signature*

Clear
Date*

MonthDayYear
Date
As a Teacher, I will be responsible for...
1. Helping each student grew to his/her fullest potential.
2. Providing an environment conductive to learn.
3. Supplying clear evaluationsof student's progress and achievement to both students and parents.
Teacher Signature

Clear
Date*

MonthDayYear
Date
As a Parent, I will be responsible for...
1. Seeing that my child attends school regularly and on time.
2. Providing a home environment that encourages my child to learn.
3. Instill a value for education within my child.
Parent Signature*

Clear
Date*

MonthDayYear
Date
As the Administration, we will be responsible for...
1. Helping scholars meet their commitments, as expressed in these pledges by students, families, staff and administration in the communities.
2. Molding a school district and community where everyone can keep their promises with each other.

Anti-Bully Policy
Bridges Preparatory Academy believes that all students have a right to a safe and healthy school environment. Bridges Preparatory Academy has an obligation to promote mutual respect, tolerance and acceptance.

Bridges Preparatory Academy will not tolerate behavior that infringes on the safety of any student. A student shall not intimidate or harass another student through words or actions. Such behaviors include: direct physical contact, hitting or shoving; verbal assaults, such as teasing or name calling and social isolation or manipulation.

Bridges Preparatory Academy expects students and/or staff to immediately report incidents of bullying to the principal or staff. Staff is expected to immediately intervene when they see a bullying incident occur. Each complaint of bullying will be promptly invesitaged. This policy applies to students on school grounds, while traveling to and from school and/or during school sponsored activities.

Teachers will discuss this policy with their students in age-appropriate ways and will assure them that they need not endure any form of bullying. Students who bully are in violation of this policy and are subject to disciplinary action up to and including expulsion.

Bridges Preparatory Academy has adopted a Student Code of Conduct to be followed by every student while on school grounds, while traveling to and/or during school sponsored activities.

The Student Code of Conduct includes, but is not limited to:
- Any student who engaged in bullying (including instigating) may be subject to disciplinary action up to and including expulsion. Bullying in any form is not tolerated. NO EXCEPTIONS.
- Students are expected to immediately report incidents of bullying to the principal or designee.
- Students can rely on staff to promptly investigate each complaint of bullying in a thorough and confidential manner.
If complainant student or the parent of the student feels that appropriate resolution of the investigation or complaint has not been reached, the student or the parent of the student should contact the principal or executive director. The school system prohibits retaliatory behavior against any complainant or any participant in the complaint process.

The procedures or intervening in bullying behavior include, but are not limited to, the following:
- All staff, students and their parents will receive a summary of this policy prohibiting bullying at the beginning of the school year as part of the enrollment packet, as part of the student handbook and as part of the school system's notification to parents.
- The school will make reasonable efforts to keep a report of bullying and the results of the investigation confidential.
- Staff is expected to immediately intervene when they see a bullying incident occur.
- People witnessing or experiencing bullying are encouraged to report the incident , such reporting will not reflect on the victim or witnesses in any way.
I have read the above statements, agree to abide by them at all times, and promise to abide by the anti-bully policy.
Student Signature*

Clear
Date*

MonthDayYear
Date

Social Media Consent & Release Form
Student Name*

First NameLast Name
Grade*
Throughout the school year students may be highlighted in an effort to promote our schools activities & achievements. For example, students may be featured in materials to raise public awareness of our school through social media accounts, school websites or other forms of media.

I, as the parent or guardian hereby give BPA and its employees, representatives, and authorized media organizations permission to print, photograph, and record for my child for use in audio, video, film, or any other electronic, digital and printed media.

This is with the understanding that neither BPA nor its representatives will reproduce said photographs, videos, interviews, or likeness for any commercial value or receive monetary gain for use of any reproduction/broadcast of said photograph or likeness. I am also fully aware that I will not receive monetary compensation for my child's participation.

I further release and relieve BPA, its Board of Directors, employees, and other representatives from any liabilities, known or unknown, airising out of the use of this material.

I certify that I have read the Media Consent and Release Liability statement and fully understand its terms and conditions.
Parent/Guardian Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
If you DO NOT wish to give consent please check the box below and sign

I do not consent to the above statement
Parent/Guardian Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date

Cellphone Policy
We are making our school a phone-free space to improve teaching and learning using a system called Yondr. Yondr has been implemented in over 1,000 schools across 21 countries to facilitate an engaged learning environment.

We believe that phones have great utility. We have also found that learning and social behavior improve drastically when students are fully engaged with their teachers and classmates.

The Yondr Program utilizes a simple, secure pouch that stores a phone. Every student will secure their phone in a personally assigned Yondr pouch when they arrive at school. Students will maintain possession of their phones and will not use them until their pouches are opened at the end of the school day. Students are required to bring their Yondr pouch to and from school each day and are responsible for their pouch at all times.

Yondr recently surveyed over 900 school partners to measure the effects of creating phone-free educational environments. These schools achieved notable progress in multiple areas:
- 65% of schools saw an improvement in academic performance
- 74% of schools saw an improvement in student behavior
- 83% of schools saw an improvement in student engagement in the classroom
Pouch Damage/Lost Pouch/Using Phone During School

If a student damages or loses their Pouch they will be entitled to pay a fee of $20 to replace the pouch as well as a parent meeting to go over rules of pouch use.

If a student is caught on their phone, Administration will collect the phone/Pouch and call home for a Parent Pickup and lose phone privileges for a month. The secong time a student is caught he/she will no longer be able to bring a phone to school. If caught with a phone the student will be suspended for not following rules.

Forgotten Pouch

If a student forgets their Pouch, they will be given a temporary pouch for the first offense. If the student forget their pouch a second time their phone will be collected and Admin will call home to remind the Parent of the policy. The phone will be returned to the parent/guardian picking up the student.
Student Signature*

Clear
Date*

MonthDayYear
Date
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date

Release of Records

Permission is hereby granted to
Previous School Name:*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Name*

First NameLast Name
Grade*
The above student has registered at: Bridges Preparatory Academy

Please release the following:
- Health Records
- Grades (including in progress at the time of leaving school)
- Results of achievement and intelligence test
- Personality rating and other similar data
- Any material pertinent to the growth of the student
- Any psycological testing or Child Study Team information, including the most recent:
  - Educational Evaluation or Psychological Assessment
  - Social Worker History
Written information is to be sent to the attention of:

Bridges Preparatory Academy

Address: 400 S Santa Fe Ave Compton, CA 90221

Electronic information is to be sent to: Sabrina@bpacompton.org
Authorization to Release of Pupil's Records

I have enrolled my child in Bridges Preparatory Academy and authorize you to release the above named information so that we may plan a program for this student
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Bridges Preparatory Academy Check Off List

Student Information

Parent/Guardian Information

Household Information

Emergency Contacts

Student Night time Residency Questionnaire

Medication Authorization Form

Medical Declaration

Release of Information

Title 1

Anti-Bully Policy

Social Media Consent & Release Form

Cellphone Policy

Release of Records