Enrollment Form

BART Charter Public School Enrollment Application

Please submit one application per child. The next rolling enrollment deadlines for the 2019-2020 school year for grades 6-10 is Thursday, October 10, 2019 at 12:00 p.m. Lotteries, if necessary, are held at 2 p.m. at the Adams Town Hall on Thursdays. Return completed application to BART Charter Public School, Attention: Enrollment Team, One Commercial Place, PO Box 267, Adams, MA 01220. Phone: 413-743-7311 or Fax: 413-743-7327. If you need a Spanish translation, please contact Erin Hattaway at 413-743-7311, ext. 712.

Please answers all questions marked with an asterisk (*)

Student Last Name, First Name & Middle Name (Fill out one form for each student participating in the enrollment process)*

Answer Required

Student Date of Birth*

Answer Required

Student Place of Birth (Town/City, State)*

Answer Required

Residential Address (Address, City/Town, State, Zip Code)*

Answer Required

Student mailing address (if the same as residential, please type "same")*

Answer Required

Current school name and location*

Answer Required

Previous school name and location*

Answer Required

If the enrolling student has a sibling(s) currently attending BART, please provide their name(s) below

Answer Required

Primary Guardian name and relationship to child (Name, Relationship)*

Answer Required

Primary Guardian residential address*

Answer Required

Primary Guardian mailing address (if the same as residential, please type "same") *

Answer Required

Primary Guardian phone number (list number and type of phone: cell, home, daytime)*

Answer Required

Primary Guardian alternate phone number (list number and type of phone: cell, home, daytime)*

Answer Required

Primary Guardian email address

Answer Required

Secondary Guardian name and relationship to child (Name, Relationship)

Answer Required

Secondary Guardian residential address

Answer Required

Secondary Guardian mailing address (if the same as residential, please type "same")

Answer Required

Secondary Guardian phone number (list number and type of phone: cell, home, daytime)

Answer Required

Secondary Guardian alternate phone number (list number and type of phone: cell, home, daytime)

Answer Required

Secondary Guardian email address

Answer Required

How did you hear about BART? (check all that apply)

Answer Required

Friend/relative

Online research

District school referral

Radio advertisement

Radio news story

Newspaper advertisement

Newspaper story

In the event that an admissions lottery is necessary, the school will announce students’ names as they are drawn in a public forum. If you would prefer to have your child’s name withheld from public mention, please indicate so here:

Answer Required

Yes

I have read and understand the enrollment process & school program provided to me and would like to enroll my child into the BART Charter Public School. This form is not valid without the signature of the parent/legal guardian (First, Last)*

Answer Required

Date of application*

Answer Required

NOTIFICATION OF POLICY REGARDING RELEASE OF STUDENT INFORMATION

According to Massachusetts Law, (603 CMR 23.07(4)(a)) the school may release Directory Information to third parties without consent. Listed below is a “Third Parties List” to whom the Berkshire Arts & Technology Charter Public School seeks authorization for the release of directory information. Directory information may include the students’ name, address, telephone number, date and place of birth, major field of study, dates of attendance, weight and height of members of athletic teams, class, participation in recognized school activities and sports, degrees, honors, awards, and post-high school plans. Except for information described in 603 CMR 23.07 (4)(a), personally identifiable information from a student record shall only be released to a third party on the condition that he/she will not permit any other third party to have access to such information without the written consent of the eligible student or parent. BART School Volunteers BART Parent Advisory Council (CFAC) School Fundraising Programs Contractors Working for BART (e.g., Dufour Bus) Sending district school (e.g., North Adams Public Schools for Residents of North Adams) MA Charter Public School Association MA Department of Elementary and Secondary Education BART Charter Public School will not release any information to any third party not listed above without providing a public notice to parents and eligible students about the type of information it may release under 603 CMR 23.07 and allow a reasonable time after such notice to request that this information not be released without the prior written consent of the parent or eligible student. To learn more about laws pertaining to student records, visit www.doe.mass.edu or you can obtain a copy of the “Education Laws & Regulations/Student Records” in our main office.

Release of student information*

Answer Required

I give BART Charter Public School consent to release directory information to the list of approved third parties above. I further understand that BART Charter Public School will notify me in accordance with 603 CMR 23.07 with any intent to release directory information to third parties that were not previously listed and provide me with the opportunity to opt out

I do not want my information shared with any third party organization, though I understand that the school is required to share some student information with the Massachusetts Department of Elementary and Secondary Education

Is there any further information you'd like to share, or questions you have? Please write below.

Answer Required

Please fix the highlighted areas below before submitting.

Enrollment Form