Bradley County Schools Registration Form Bradley County Schools Registration Form - Website Version Welcome to the Bradley County Schools Technology website. Registration Form for NEW students to Bradley County Schools. Please complete the form below. Required fields marked with an asterisk * If a question is not applicable, please leave the section blank or use N/A. You can change the language of the form at the bottom of the page. School Year*2022-20232023-2024School Name*Please select the school you wish to attend. Note for Preschool applicants: Please select Preschool as the School.PreschoolBlack Fox ElementaryBradley Central High SchoolBradley County Virtual SchoolCharleston ElementaryGOAL AcademyHopewell ElementaryLake Forest Middle SchoolMichigan Avenue ElementaryNorth Lee ElementaryOak Grove ElementaryOcoee Middle SchoolPark View ElementaryProspect ElementaryTaylor ElementaryValley View ElementaryWalker Valley High SchoolWaterville Community ElementaryPlease select the school you wish to attend. Note for Preschool applicants: Please select Preschool as the School.Grade*PreschoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade Student Name (as it appears on the Birth Certificate):First* Middle* Last* Preferred Name Gender:Gender Male Male Gender Female Female Date of Birth* MM slash DD slash YYYY Country of Birth* State of Birth* County of Birth* City of Birth* Ethnicity - Please select Hispanic or Non-Hispanic*Hispanic Hispanic Non-Hispanic Non-Hispanic Race (Check all that apply)* Asian American Indian/Alaskan Native Black/African American Pacific Islander/Native Hawaiian White Student Information:Student's Address* Student's City* Student's State* Student's Zip* Student's Home Phone Number*List other Children in Family When a call is made about your child, what number should we call? Call #1*Call #2*Call #3Call #4Special Services he/she receives: [Pick all that apply]Special Service Received: RTI Reading RTI Math Speech Does he/she have an IEP? Yes or 504 plan? Yes Emergency Contact Information [other than parent]:Emergency Contact Name Emergency Contact PhoneEmergency Relationship Check Out Information: Names listed below may check out my child Custody:* Both Parents Mother Father State Custody Other Legal Guardian Custody Issue? No Yes What, if any, custody issues do we need to be aware of?Mother's Information:Mother's Name* Maiden name* Mother's Address (include City, State, Zip)* Mother's Home Phone*Mother's Cell NumberEmployed By: Mother Mother's Work NumberMother's Email Address Father's Information:Father's Name* Father's Address (include City, State, Zip)* Father's Home Phone*Father's Cell NumberEmployed by: Father Father's Work NumberFather's Email Address Does the parent/legal guardian presently serve in the: Active Military National Guard Military Reserve Military Custody Other - Legal Guardian Information. If you do not need this section, please leave blank.Custody/Legal Guardian's Name Custody/Legal Guardian's Address (include City, State, Zip) Custody/Legal Guardian's NumberCustody/Legal Guardian's Cell NumberEmployed by: Custody/Legal Guardian Custody/Legal Guardian's Work NumberCustody/Legal Guardian's Email Address Custody/Legal Guardian's Relationship to Student Last School Attended Information. If this is your child's first time in school, please leave blank.School Last Attended by Student School Last Attended Address School Last Attended City School Last Attended State School Last Attended Zip School Last Attended Phone NumberSchool Last Attended Fax NumberFor children entering Kindergarten or First Grade check if attended - Pre-School Yes For children entering Kindergarten or First Grade check if attended - Day Care Yes For children entering Kindergarten or First Grade check if attended - Kindergarten Yes Do you plan to enter another school next year? Yes No If Yes, where? Parent or Legal Guardian's Signature* Date* MM slash DD slash YYYY Student Name* School*PreschoolBlack Fox ElementaryBradley Central High SchoolBradley County Virtual SchoolCharleston ElementaryGOAL AcademyHopewell ElementaryLake Forest Middle SchoolMichigan Avenue ElementaryNorth Lee ElementaryOak Grove ElementaryOcoee Middle SchoolPark View ElementaryProspect ElementaryTaylor ElementaryValley View ElementaryWalker Valley High SchoolWaterville Community ElementaryParent Guardian Name* Student Phone Number* STUDENT MEDICAL INFORMATION - My student has the following health conditions that may require special care during school hours:MY CHILD HAS NO SPECIAL HEALTH NEEDS - If NO, please check box and skip to Primary Care Physician. MY CHILD HAS NO SPECIAL HEALTH NEEDS Please complete ONLY those that apply:Asthma Yes Asthma Triggers Asthma Treatment at home Yes an inhaler will be needed and provided for use during school Yes Diabetes Yes Diabetes - treated with Diet Yes Diabetes - treated with insulin injections or pump Yes Food Allergy Yes Food Allergy to: Describe Reaction Food Allergy: Current Required Treatment Food Allergy: Other Allergy Yes Other Severe Allergy to: Describe Reaction Other Allergy: Current Required Treatment Other Allergy: Vision Impairment Yes Glasses Yes Contacts Yes Hearing Impairment Yes Hearing Left Yes Hearing Right Yes Physical Impairment Yes Describe Physical Impairment: Seizure Disorder Yes Seizure Type: Seizure Treatment at home Yes Seizure Treatment: emergency medication is ordered and will be provided for use at school Yes Seizure Medication: ADD/ADHD Yes ADD/ADHD: medicated at home Yes ADD/ADHD: will require medication during school hours (as prescribed by MD) Yes Other Medical Issues Not Listed Above: Primary Care Physician Doctor Office Phone NumberConsent:The information provided above is true and accurate to the best of my knowledge. Yes I acknowledge that students cannot transport medication of any kinds. The parent must bring medication into school and sign appropriate paperwork. Yes It is my responsibility to notify the school if my child's medical condition changes and/or they have developed any medical needs that may require attention during school hours. Yes The school may use over-the-counter first aid products such as Neosporin, Benadryl spray/cream, wound cleanser, etc (Topical First Aide) as needed for my student as they have no known sensitivity to these items. This does not include medication taken by mouth. Yes Medicine by mouth? Yes No The school may use over-the-counter Tylenol, Ibuprofen, cough drops, or TUMS as needed for my student as they have no known sensitivity to these items. Yes Medicine by mouth Tylenol, Ibuprofen, cough drops, or TUMS? Yes No HOME LANGUAGE SURVEY - In an effort to comply with Title VI of the Civil Rights Acts, we have been asked to survey parents to see if we are meeting the needs of students who may speak English as their second language. What is the first language that your child learned to speak?* What language does your child speak most often outside of school?* What language do people usually speak in your child’s home?* Month Enrolled First School Day Enrolled First School Year Enrolled First School Month entered US Day entered US Year entered US STUDENT RESIDENCY INFORMATION - As part of the ESSA requirements, each school registrant should complete the following information. WHERE DOES THE STUDENT STAY AT NIGHT?in His/Her home owned or rented by parent? Yes in a shelter? Yes with a relative or friend? Yes in a motel/hotel? Yes in housing that is inadequate? Yes unsheltered? Yes other? Yes If other, please explained:Thank you for registering your student with Bradley County Schools. The principal or designee of the school you are applying to attend will contact you soon. Requirements for all new students: Immunization Record on a TN Certificate of Immunization Updated Physical for Kindergarten – Physical must be completed during the current year. Student Medical Form Custody Paperwork – if needed Proof of Address – must show parent name and service connection address Proof of Birth, one of the following forms: Birth Certificate – issued by a government Passport issued by any nation (translated) Immigration documentation Decree of adoption issued by a court Other official documentation showing date of birth and parent’s name (refer to board policy 6.203) Requested if available: Child’s Social Security Card Parent or Legal Guardian's Signature* Date* MM slash DD slash YYYY Consent* All information is correct to the best of my ability. Δ Share this:PrintMoreFacebookTwitterEmail