2023-2024 Registration – Blue River Career Programs

Blue River Registration

Step 1 of 4 - BLUE RIVER CAREER PROGRAMS 2022-2023 STUDENT ENROLLMENT

STUDENT INFORMATION
Student Name*
First Last
Cell Phone*
Email*
Home Address
Street Address City State ZIP Code
Home Phone
Do you have a Home Internet?
- Yes
- No
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Home School*
Program*
Grade Level*
Date of Birth*
Race/ Ethnic Group
Gender
- Female
- Male
Mother
First Last
Mother Address
Street Address City State ZIP Code
Mother Phone
Mother Email
Father
First Last
Father Address
Street Address City State ZIP Code
Father Phone
Father Email
Guardian
First Last
Relationship
Address
Street Address City State ZIP Code
Email
Phone Number
EMERGENCY CONTACT INFORMATION
Guardianship
Mother's Name
First Last
Home Phone Number
Mother's Employer
Work Phone Number
Cell Phone Number
Father's Name
First Last
Home Phone Number
Father's Employer
Work Phone Number
Cell Phone Number
Guardian Name
First Last
Relationship
Home Phone Number
Guardian’s Employer
Work Phone Number
Cell Phone Number
Other individuals who can pick-up student from school
Emergency Contact 1
Phone Number
Relationship
Emergency Contact 2
Phone Number
Relationship
Emergency Contact 3
Phone Number
Relationship
No Contact With Student Orders
First Last
Relationship
Special Medical Considerations

EMERGENCY MEDICAL AUTHORIZATION PERMIT

Blue River Career Programs
Student Name
First Last
Program*
I give my consent for emergency medical and surgical treatment of the above named minor in a licensed hospital by a licensed physician should his/her condition so require it in my absence. I understand that in such case reasonable attempts would first be made to contact me, time and conditions permitting.
As long as the medical or surgical treatment considered necessary in the situation is in accordance with generally accepted standards of medical practice for the particular type of injury or illness involved, I impose no specific limitations or prohibitions regarding treatment other than those that follow: (if none, so state)
This authorization is effective for the following time period:
MM slash DD slash YYYY
to:
MM slash DD slash YYYY
Parent or Legal Guardian’s Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Cell Phone
Work Phone
Other Parent or Legal Guardian’s Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Cell Phone
Work Phone
MEDICAL/INSURANCE INFORMATION
Family Doctor
First Last
Phone
Medical Insurance Carrier
ID #
Member’s Name
First Last
Group ID
Account #
Medical History
List allergies, if any, including medication.
Last Tetanus Immunization
MM slash DD slash YYYY

BLUE RIVER CAREER PROGRAMS INTERNET and OTHER ON-LINE ACCESS CONTRACT/STUDENT COMPUTER USE AGREEMENT
Student Name
First Last
BRCP Program*
Name of Parent or Guardian
First Last
Hidden
Date
MM slash DD slash YYYY
In exchange for the use of BRCP’s INTERNET Connection or other on-line access, I/We, understand and agree to the following:
1. That the use of BRCP’s INTERNET Connection or other on-line access is a privilege that may be revoked by the administrators of the system at any time for abusive conduct. Such conduct would include, but not be limited to, the placing of unlawful information on the system, and defamatory, abusive, obscene, profane, sexually oriented, threatening, harassing, racially offensive, or illegal material, subscribed to or received by the user. The staff of BRCP will be the sole arbiter of what constitutes abusive conduct as described above.
2. That the use of BRCP’s INTERNET Connection or other on-line access is a privilege that may be revoked by the administrators of the system at any time for conduct that embarrasses, harms, or in any way distracts from the good reputation of BRCP and its faculty and staff, or any organizations, groups, and institutions with which BRCP is affiliated. The staff of BRCP will be the sole arbiter of what constitutes this unacceptable behavior.
3. That BRCP reserves the right to review any material stored in files or electronic mail and will edit or remove any material that the staff, at its sole discretion, believes may be in violation of this agreement.
4. That all information services and features contained in BRCP’s INTERNET Connection or other on-line access are intended for the educational use of its patrons, and any commercial or unauthorized use of those materials or services in any form is expressly forbidden.
5. To abide by all rules and regulations of system usage as described by the Acceptable Use Policy and the staff of BRCP.
6. In consideration for the privilege of using BRCP’s on-line services and in consideration for having access to the information contained on it, I hereby release and hold harmless BRCP and its faculty and staff, and all organizations, groups, and institutions with which BRCP’s INTERNET Connection or other on-line access is affiliated for any and all claims of any nature including third party claims arising from my use or inability to use BRCP’s on-line services.
7. My access to any use of BRCP’s on-line services is subject to such limitations as may be established by the administrators of the system, which may be changed from time to time. I understand my access may be terminated at any time.
I/We understand and agree to the terms in exchange for the use of BRCP’s INTERNET Connection or other on-line access.
For the privilege of using computers, printers, and related equipment at Blue River Career Programs for my assignments, I agree to:
1. Log on with my username/password only
2. Use the equipment only for work approved by the classroom teacher
3. Save files in my own network folder as directed by the instructor
4. Use appropriate file names
5. Ask for help when needed
6. Leave computer programs unchanged
7. Keep password secret
8. Use a printer only when needed and for appropriate files
9. NOT attempt to breech the security of the network for any reason
10. NOT attempt to use proxies or any other means of bypassing the content filter
11. Immediately report to the instructor any virus message which appears on the monitor
12. Log off computer when finished
I agree to terms for the privilege of using computers, printers, and related equipment at Blue River Career Programs for my assignments
Please be advised that access to Internet and other on-line services may contain information that could be defamatory, abusive, obscene, profane, sexually oriented, threatening, harassing, racially offensive, or illegal.
Signature of Student/User
Signature of Parent/Guardian
ATTENDANCE REQUIREMENTS

Blue River Career Programs mission is to provide students with relevant and timely hands-on technical training in their chosen field. Most of our technical classes are three hours in length which are three times longer than a regular high school class. Therefore, it is essential that your child be in attendance regularly.

Blue River Career Programs’ school calendar may differ from that of your child’s home high school. All students are required to be in attendance when BRCP is in session.

Please make every effort to have your child attend class prepared to engage in learning and able to work safely. Schedule appointments and family events outside of class time. If an absence is unavoidable, it is very important that you call Blue River Career Programs. You should also report the absence to your student’s home school.

TO REPORT AN ABSENCE:
(1) Dial 317-392-4191
(2) Press #3 for the attendance line.

Student Name*
First Last
Consent to Release
I AGREE to release information regarding my enrollment (emancipated student) or my student’s enrollment in a career or technical education course to potential employers that contact the school to recruit students with particular career and technical skills. The school shall also provide enrollment information to the Department of Workforce Development (DWD) through the InTERS reporting system. The DWD may provide the enrollment information to potential employers that contact the DWD to recruit students with particular career and technical education skills.
Consent to Refuse
I REFUSE to release information regarding my enrollment (emancipated student) or my student’s enrollment in a career or technical education course to potential employers that contact the school to recruit students with particular career and technical skills.
I understand the information may be released orally or in the form of copies of written enrollment information, when preferred by the requester. I have a right to inspect any written information released pursuant to this Consent. I understand I may revoke this Consent upon providing written notice to the Governor's Workfoce Cabinet's Office of Career and Technical Education by emailling CTE@gov.IN.gov. I further understand that until this revocation is made, this consent shall remain in effect and my enrollment information will continue to be provided as detailed in this Consent.
Parent Or Emancipated Student*
First Last
Signature of Parent or Emancipated Student
Date
MM slash DD slash YYYY
Student Email

Blue River Registration

Step 1 of 4 - BLUE RIVER CAREER PROGRAMS 2022-2023 STUDENT ENROLLMENT

STUDENT INFORMATION

EMERGENCY CONTACT INFORMATION

EMERGENCY MEDICAL AUTHORIZATION PERMIT

Blue River Career Programs

MEDICAL/INSURANCE INFORMATION

BLUE RIVER CAREER PROGRAMS INTERNET and OTHER ON-LINE ACCESS CONTRACT/STUDENT COMPUTER USE AGREEMENT

ATTENDANCE REQUIREMENTS

TO REPORT AN ABSENCE: