Bridgeway Academy Pre-Registration Form

Bridgeway Academy Pre-Registration Form
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age as of September 1. 2026
Place of Birth
Gender
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Level
School Year
School Last Attended (if applicable)
What primary and/or secondary insurance does your child have?
(Information needed for ABA Therapy services)
Parent/Guardian's Information
Parent/Guardian's Name - Primary

First NameLast Name
Email
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian's Name - Secondary

First NameLast Name
Email
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
File Upload

Please upload any applicable documents to include Autism Diagnosis Report, Speech or Occupational Reports, immunization records*, hearing and vision screening (form 3300 is acceptable), and/or most recent report cards/documents (if child attended school).
Upload
Health History
If the student have any allergies, please list them down below:
Does the student currently taking any medications? If yes, please list them down below:
Was the student previously hospitalized or undergo any surgery?
Does the student have any medical or mental health conditions that you would like to declare?
Does your child currently receive ABA Therapy? If so, where? Please upload a copy of the current treatment plan below.
Reminders
ABA THERAPY. ABA Therapy services are contracted through Success on the Spectrum Douglasville and have a separate enrollment and evaluation process. Please contact SOS (douglasvilleOM@successonthespectrum.com) for information regarding their enrollment process.

SCHEDULE. Student acceptance will be within a week of application submittal. You will need to confirm your child's spot by May15th and complete the enrollment package by May 31st to secure your child's seat or it will be released to the next student on the wait-list.

TUITION. School tuition for 2026-2027 will require a tuition agreement or scholarship award letter with allocation to Bridgeway Academy as a curriculum service provider (Georgia Promise Scholarship).

ACCEPTANCE. Once your child's application is reviewed and accepted for admittance, a complete enrollment package and $150 registration fee will be due (applied to activity fee if scholarship is awarded). We will also need a copy of immunization records or a waiver, copy of the student's birth certificate, and a letter of intent to homeschool for Georgia Department of Education.
Date Signed

MonthDayYear
Date
Parent/Guardian Signature
Should be Empty:

Bridgeway Academy Pre-Registration Form

Parent/Guardian's Information

File Upload

Health History

Reminders