High School Program Parent Form

BTG High School Program Registration: Parent/Guardian Consent Form
Bridge the Gap provides comprehensive academic, social, and emotional support to students and families in the Tamalpais Union High School District and the Shoreline Unified School District.

Our mission is to ensure that every student graduates from high school prepared to pursue their greatest potential; whether that means attending a four-year university, enrolling in vocational training, or beginning a career. We are committed to helping students build pathways toward economic sustainability and independence.

Our vision is for all students to have equitable access, opportunities, and choices to achieve their fullest potential.

Research consistently shows that higher education is one of the most powerful ways for under-resourced and first-generation students to increase lifetime opportunities and earnings. Bridge the Gap exists to make that pathway possible.

Program Benefits & Expectations
Families who meet the Bridge the Gap (BTG) minimum requirements will be eligible for the following:
- Reduced pricing for high school yearbooks, school dance tickets, and prom tickets
- College field trips
- Career field trips
- “Cross the Bridge” - Summer Residential Program - *FREE*
- At least two college application fees paid
- Access to Bridge The Gap’s college scholarships
- Financial Aid Advising & Coaching
- Financial assistance with education-related expenses
Program Commitments
As a parent/guardian, I understand that my child’s participation in Bridge the Gap (BTG) comes with important commitments to ensure their academic success and preparation for college and/or career.

Student Commitments
- Attend Study Hall at least once per week for one hour.
- Meet with a BTG high school staff at least once per month.
- Participate/Engage in our Summer Cross The Bridge College Immersion Program, a one week overnight intensive. *July
- Attend at least one college tour with Bridge the Gap. *October & *February
Parent/Guardian Commitments
- Meet with a BTG staff member once per semester or
- Attend at least one BTG community meeting per semester.
  - *October 8 & February 11, 2027
Acknowledgment & Agreement

By signing below, I confirm that I understand and agree to the commitments and expectations of Bridge the Gap.
Student Information
Student Name

First NameMiddle NameLast Name
Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Student Additional Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your child have an Individualized Education Plan (IEP)?
Does your child receive any school support services?
If yes, please describe the services your child receives:
Does your student participate in any extracurricular activities (sports, classes, clubs, or programs which might interfere with Bridge the Gap College Prep scheduling?
If yes, please list the extracurricular activities:

Additional Family Information

The following information is used for Program Grant and Scholarship Purposes ONLY. This information is aggregated and can not be used to identify you.
Does your child have additional siblings?
Did your child qualify for free/reduced priced lunch at school?
List the name, grades, and schools of your child's siblings.
How many adults are in the household?
How many children under 18 years old are in the household?
Total Household Size
The following question asks about your family's monthly gross (pre-taxes) income. This information is used internally for data and funding purposes only.
What is the estimated monthly gross income amount of the household?
What is the estimated annual gross income amount of the household?

Parent/Guardian Information
Parent/Guardian #1 Name

First NameLast Name
Parent/Guardian #1 Email
example@example.com
Parent/Guardian #1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #1 Relationship to Student
Parent/Guardian #1 Address the Same as Students?

Additional Parent/Guardian Information

Optional, click 'next' to skip this page
Parent/Guardian #2Name

First NameLast Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #2 Relationship to Student
Parent/Guardian #2 Address the Same as Students?

Emergency Contact/Authorized Persons Information

Optional, click 'next' to skip this page
When I am unable to pick my child up or we are unable to reach you, I give the Program staff permission to contact or release my child to the following contact.
Emergency Contact/Authorized Persons

First NameLast Name
Emergency Contact Email
example@example.com
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Relationship to Student

Emergency Medical Release
Please describe student food allergies, medications, or accommodation needs we should be aware of to support the student's participation safely in the program.
I understand that it is my responsibility to advise BTG of any specific relevant medical needs or accommodations for my student.

Photo and Media Release Agreement
Bridge the Gap may take photos or record videos during programming on school sites, college tours, workshops, or in direct advising sessions. By agreeing below, you give permission for photos and videos to be utilized for educational, promotional, or fundraising purposes.
I give permission for the student's image, voice, and likeness to be shared by Bridge the Gap.

Academic Release
In order to support students in both high school and post-secondary success, BTG utilizes academic records from the school they are enrolled. This includes their transcripts and attendance data requested from the school or district.

By agreeing below, you are allowing the release of records to BTG staff while the student is registered with the program.
By agreeing below, I give my consent for the release of educational records from the student's school or district to Bridge the Gap upon request. I understand this release can be withdrawn at any time.
Should be Empty:

BTG High School Program Registration: Parent/Guardian Consent Form

Student Information

Student Additional Information

Additional Family Information

Parent/Guardian Information

Additional Parent/Guardian Information

Emergency Contact/Authorized Persons Information

Emergency Medical Release

Photo and Media Release Agreement

Academic Release