• Brookhaven Treatment and Learning Center 2021-2022

    School Year Activity Release Form
  • Brookhaven Treatment and Learning Center (“Brookhaven”) regularly

    offers the following activities for clients in our care. These include but

    not limited to: arts and crafts, fishing, land sports, outdoor living skills,

    rocketry, swimming, woodworking, as well as other activities. The

    walking trips listed below will be completed off of the Brookhaven

    campus, and will include but are not always limited to the below

    locations. For trips requiring students to be transported off of the

    Brookhaven campus and further than walking distance, a separate

    permission form will be sent to parents/guardians.

  • At times we do offer students to attend learning experiences and

    rewards off campus. These may include but are not limited to VTC

    Shape Pool in Randolph, VT, trips to Lebanon, NH/Norwich,VT

    area (Montshire Museum, HOP at Dartmouth College campus).

    By signing, you are providing permission for your student to

    participate in any off-campus activities/rewards provided by Brookhaven Treatment and Learning Center. Your student will be

    with Brookhaven staff, and potentially transported by Brookhaven

    staff.

  • Permission for Enrollment and Release of Brookhaven from

    Liability

    As parent or legal guardian of Participant, I verify that Participant is in

    good physical condition and is physically capable of participating in the

    activities offered by Brookhaven. I have reviewed the Brookhaven

    walking trips and acknowledge that I understand the activities offered by

    Brookhaven can be hazardous because of the risk of injury inherent in

    such activities. Nonetheless, as guardian of said child, I consent to his

    participation in above checked field trips as well as on and off campus

    activities during the 2019-2020 Brookhaven Treatment and Learning

    Center school year. I agree to indemnify and hold harmless, Brookhaven

    Treatment and Learning Center, and its employees, in the event of any

    injury and/or death from said child's participation; whether on site, or off

    site.

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