Blue River Registration Step 1 of 5 - BLUE RIVER CAREER PROGRAMS 2025-2026 STUDENT ENROLLMENT 0% STUDENT INFORMATIONStudent Name* First Last Cell Phone*Email* Home Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneDo you have a Home Internet? Yes No Mailing Address* Street Address Address Line 2 City SelectAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home School*SelectSHS – Shelbyville High SchoolTCHS – Triton Central High SchoolSWHS – Southwestern High SchoolMHS – Morristown Jr. Sr. High SchoolWHS – Waldron Jr. Sr. High SchoolProgram*SelectAuto Collision RepairAutomotive ServicesConstruction TradesCriminal JusticeCulinary ArtsEducation ProfessionsFire & Rescue yr. 1Fire & Rescue/EMTEducation ProfessionsHealth Sciences/CNAHealth Sciences/CCMAHuman & Social ServicesWelding TechnologyWork Based LearningGrade Level*SelectGrade 9Grade 10Grade 11Grade 12Date of Birth*MMMM123456789101112DDDD12345678910111213141516171819202122232425262728293031YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Race/ Ethnic GroupSelectAmerican Indian/Alaskan NativeBlack (Not Hispanic)Asian American/Pacific IslanderHispanicWhite (Not Hispanic)Multi-raceGender Female Male Mother First Last Mother Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mother PhoneMother Email Father First Last Father Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Father PhoneFather Email Guardian First Last RelationshipSelectAuntBrotherFatherFriendGrandfatherGrandmotherMotherNeighborSisterStep-parentUncleOtherAddress Street Address City SelectAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Phone Number EMERGENCY CONTACT INFORMATIONGuardianshipSelectMotherFatherGuardianBoth ParentsMother's Name First Last Home Phone NumberMother's EmployerWork Phone NumberCell Phone NumberFather's Name First Last Home Phone NumberFather's EmployerWork Phone NumberCell Phone NumberGuardian Name First Last RelationshipSelectAuntBrotherFatherFriendGrandfatherGrandmotherMotherNeighborSisterStep-parentUncleOtherHome Phone NumberGuardian’s EmployerWork Phone NumberCell Phone NumberOther individuals who can pick-up student from schoolEmergency Contact 1Phone NumberRelationshipSelectAuntBrotherFatherFriendGrandfatherGrandmotherMotherNeighborSisterStep-parentUncleOtherEmergency Contact 2Phone NumberRelationshipSelectAuntBrotherFatherFriendGrandfatherGrandmotherMotherNeighborSisterStep-parentUncleOtherEmergency Contact 3 Phone NumberRelationshipSelectAuntBrotherFatherFriendGrandfatherGrandmotherMotherNeighborSisterStep-parentUncleOtherNo Contact With Student Orders First Last RelationshipSelectAuntBrotherFatherFriendGrandfatherGrandmotherMotherNeighborSisterStep-parentUncleOtherSpecial Medical Considerations EMERGENCY MEDICAL AUTHORIZATION PERMIT Blue River Career ProgramsStudent Name First Last Program*SelectAuto Collision RepairAutomotive ServicesConstruction TradesCriminal JusticeCulinary ArtsEducation ProfessionsFire & Rescue yr. 1Fire & Rescue/EMTEducation ProfessionsHealth Sciences/CNAHealth Sciences/CCMAHuman & Social ServicesWelding TechnologyWork Based LearningI 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 SelectAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell PhoneWork PhoneOther Parent or Legal Guardian’s Name First Last Address Street Address Address Line 2 City SelectAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell PhoneWork Phone MEDICAL/INSURANCE INFORMATIONFamily Doctor First Last PhoneMedical Insurance CarrierID #Member’s Name First Last Group IDAccount #Medical HistoryList 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 AGREEMENTStudent Name First Last BRCP Program*SelectAuto Collision RepairAutomotive ServicesConstruction TradesCriminal JusticeCulinary ArtsEducation ProfessionsFire & Rescue yr. 1Fire & Rescue/EMTEducation ProfessionsHealth Sciences/CNAHealth Sciences/CCMAHuman & Social ServicesWelding TechnologyWork Based LearningName of Parent or Guardian First Last This field is hidden when viewing the formDate 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: 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. 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. 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. 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. To abide by all rules and regulations of system usage as described by the Acceptable Use Policy and the staff of BRCP. 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. 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.Signature of Parent/GuardianFor the privilege of using computers, printers, and related equipment at Blue River Career Programs for my assignments, I agree to: Log on with my username/password only Use the equipment only for work approved by the classroom teacher Save files in my own network folder as directed by the instructor Use appropriate file names Ask for help when needed Leave computer programs unchanged Keep password secret Use a printer only when needed and for appropriate files NOT attempt to breech the security of the network for any reason NOT attempt to use proxies or any other means of bypassing the content filter Immediately report to the instructor any virus message which appears on the monitor 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 assignmentsSignature of Parent/GuardianPlease 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/UserSignature of Parent/GuardianATTENDANCE 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 This field is hidden when viewing the formConsent 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.This field is hidden when viewing the formConsent 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.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. Yes No 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 Workforce 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. 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 StudentDate MM slash DD slash YYYY Student Email STUDENT HANDBOOK ACKNOWLEDGEMENT 2024-2025Dear Student, Parent, and/or Guardian, Blue River Career Programs believes that the education of our students relies on an orderly and disciplined environment. The rules and guidelines established in this student handbook BRCP feels are reasonable for student behavior and will promote educational goals set forth by the Blue River Career Programs’ governing board, administration, faculty, and staff. Along with the other important information in this handbook, please read the pages concerning discipline procedures, school rules, and the attendance policy. If you have questions concerning these procedures, please schedule an appointment with the Student Services Coordinator. Blue River Career Programs’ student handbook is available for review by the student and the parent by going to www.brcp.net and selecting “Student and Parent Resources.” By signing this form, you acknowledge you have read the Blue River Career Programs’ student handbook and understand the policies covered within it. Student Name* First Last Date* MM slash DD slash YYYY Signature of Student/UserSignature of Parent/Guardian
