BrookEdge Academy Student Registration Form 
[IMPORTANT]
Please ensure this form is filled by an adult, if the students are under the age of 18. Fields with (*) are required and those without * are optional. One student one form. Thank you.

Filling out a form does not guarantee an actual offer of a program. BEA has the full discretion to arrange a program in a form fitting best to the student's learning need at a time feasible when staffing and other resources can be scheduled. 

This form is effective as of August 10, 2022. 

In case of amendment assistance or technical difficulties, please contact BEA by emailing to brookedgeacademy@gmail.com 
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Email *
1.First Name (Student) *
2.Last Name (Student) *
3.Preferred first name (if different from above)
4.Student's Grade (if you are filling this form in summer, then the grade the Student is entering in the following fall) *
5.Immediate Learning Interest Subjects (please choose only ONE of the following options) *
6.Specific Areas of a language learning (required to specify if you chose English, French, Spanish or Chinese in Question 5)
7. Specific Areas in Math learning (required to answer if you chose Math for Question 5)
8.Math Contest of Interest (required to answer if you choose "competitive math" for Question 7, for example, AMC8, or Math Kangaroo G3-4, etc.)
9.  Specific Areas of science learning (required to specify if you chose "Science" in Question 5) *
Required
10. Non-immediate learning interests (choose as many as those apply): 
11. Parent's Email for timely communication: *
12. Residence (in the form of city, state/province, country, for example "Toronto, Ontario, Canada" or "New York City, New York, U.S.A."). We need the information to compare against the curriculum requirements of your children.  *
13. Parent's phone number (For Emergency Contact) *
14. Parent's Sign-Off – please type your legal name. [IMPORTANT: by printing your legal name here, you:  (1) acknowledge that this form is correctly filled in; and (2) authorize BrookEdge Academy to collect and use your children's information for support of their learning needs; and(3) permit BrookEdge Academy and your children to use technology to run the education programs where necessary and appropriate; and (4) agree to receive notifications from BrookEdge Academy about similar programs of your child's learning interests. Do not submit this form if you do not wish to do so. After submission, if you want to withdraw your consents and authorization at any future point, please email office@brookedge.org.] *
15. Any other comments:
16. I identify my child/family as one member of the following groups: *
Required
Does your child have any access needs or disability accommodations? *
If yes, please describe your child's needs here.
A copy of your responses will be emailed to the address you provided.
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