Winchester Public Schools - Judith Walsh Director of Personnel swalsh@ John Danizio ... Winchester Public Schools for 2017-2018, please let us know by contacting Freda Canavan at

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<ul><li><p>Winchester Public Schools Dr. Judith Evans, Superintendent</p><p>jevans@winchesterps.org</p><p>40 Samoset RoadWinchester, MA 01890 </p><p>Phone: 781-721-7004Fax: 781-721-0016</p><p>Dr. Jennifer ElineemaAssistant Superintendent</p><p>jelineema@winchesterps.org</p><p>Pamela GirouardDirector of Special Educationpgirouard@winchesterps.org</p><p>Sean WalshDirector of Personnel</p><p>swalsh@winchesterps.org</p><p>John DanizioDirector of Finance</p><p>jdanizio@winchesterps.org</p><p>May 15, 2017</p><p>Dear Winchester Family:</p><p>Welcome to the Winchester Public Schools! According to our town census, your child is eligible for Kindergarten entrance for the 2017-2018 school year. To be eligible, children must be five years old on or before September 1, 2017. Our kindergarten program is tuition-free and runs on the same full-day schedule as grades 1-5.</p><p>Registration and other materials needed to register your child may be found on our district website at winchesterps.org, picked up at the central office at 40 Samoset Road, or picked up at your childs assigned district school. Completed registrations may be dropped off, e-mailed, or mailed directly to your assigned school. The directory of K-5 school districts by street name adopted by the school committee on November 4, 2012 may be found on our website under the Family Resources tab - Street Directory.</p><p>If you have questions about kindergarten registration or if your child will NOT be enrolling in the Winchester Public Schools for 2017-2018, please let us know by contacting Freda Canavan at fcanavan@winchesterps.org or (781) 721-7004.</p><p>We look forward to meeting your family and starting this exciting journey together.</p><p>Sincerely,</p><p>Judith A. Evans, Ed.D.</p><p>Superintendent</p></li><li><p> Winchester Public Schools REGISTRATION CHECKLIST </p><p>Welcome to the Winchester Public Schools!</p><p>In order for your child to start school, we must have all required documents. Along with the Registration for Admission Forms, please present the following documents at the time of registration. </p><p>_____ Registration Form for Admission</p><p>_____ State Mandated Race Data/Ethnicity Data Collection</p><p>_____ Emergency Contact Information Form</p><p>_____ Home Language Questionnaire</p><p>_____ Use of Student Information &amp; Images for Educational Purposes</p><p>_____ Parent Questionnaire</p><p>_____ Preschool Inventory</p><p>_____ Proof of Residency - Current Property Tax Bill, Lease Agreement</p><p>_____ Proof of Occupancy - Current Utility Bill or Notarized Occupancy Statement </p><p>_____ Birth Certificate or Passport of the child</p><p>_____ Physical Exam Forms with Immunization Records</p><p>_____ Student transcripts from current school (if transferring to WPS)</p><p>_____ Copy of IEP or Section 504 Plan (if applicable)</p><p>_____ Custody Papers/Care Giver Affidavit (if applicable)</p></li><li><p>Winchester Public Schools Registration for Admission</p><p> New Students Entering 2017-2018 </p><p>To register for Kindergarten your child must be 5 by September 1, 2017</p><p>Grade entering: K 1 2 3 4 5 6 7 8 9 10 11 12 </p><p>STUDENT INFORMATION </p><p>FirstName MiddleName LastName</p><p>DateofBirth(mm/dd/yyyy)</p><p>BirthPlace(City/State/Country)</p><p>HomeAddressCity,StateandZipCode City State Zipcode HomePhone</p><p>Gender FemaleMalenon-binary</p><p>StateMandatedEthnicity</p><p>(Chooseallthatapply)</p><p>TheWinchester PublicSchoolsarerequiredbytheStateofMassachusettstoreporteachstudentsethnicityandraceusingthe States newly defined categories. If you have questions or concerns regarding this request, please contact theDepartmentofEducationat781-338-3000.Seebackofthissheetforracecodethatbestdescribesyourchild.</p><p> AmericanIndian04orAlaskaNative04 Asian/Indian03 BlackorAfricanAmerican02 Caucasian(White) 01 NativeHawaiianorotherPacificIslander05 other_________________ HispanicorLatinoor Non-HispanicorLatino(ApersonofCuban,Mexican,PuertoRican,Southor</p><p>CentralAmerican,orofotherSpanishCultureororigin,regardlessofrace)PrimaryLanguage PrimaryLanguage(otherthanEnglish)_________________________________________________________</p><p>Studentliveswith: MotherFatherGuardian Other,specify:___________________________________________</p><p>PARENT1/GUARDIAN1-INFORMATIONFirstName LastName</p><p>Relationship</p><p>HomeAddressCity,Stateand</p><p>ZipCode City State Zipcode</p><p>HomePhone CellPhone WorkPhone</p><p>Email</p><p>Employer </p><p>PARENT2/GUARDIAN2-INFORMATIONFirstName LastName</p><p>Relationship</p><p>HomeAddress</p><p>City,StateandZipCode City State Zipcode</p><p>HomePhone CellPhone WorkPhoneEmail</p><p>Employer</p><p>Winchester Public Schools, 40 Samoset Road, Winchester, MA 01890 Phone: 781-721-7000</p></li><li><p>Winchester Public Schools State Mandated Race/Ethnicity Data Collection </p><p>Circle ONE numeric code: One Race </p><p>01 White 02 Black or African American 03 Asian 04 American Indian or Alaska Native 05 Native Hawaiian or Other Pacific Islander </p><p>Combination of Two Races 06 White &amp; Black or African American 07 White &amp; Asian 08 White &amp; American Indian or Alaska Native 09 White &amp; Native Hawaiian or Other Pacific Islander 10 Black or African American &amp; Asian 11 Black or African American &amp; American Indian or Alaska Native 12 Black or African American &amp; Native Hawaiian or Other Pacific Islander 13 Asian &amp; American Indian or Alaska Native 14 Asian &amp; Native Hawaiian or Other Pacific Islander 15 American Indian or Alaska Native &amp; Native Hawaiian or Other Pacific Islander </p><p>Combination of Three Races 16 White &amp; Black or African American &amp; Asian 17 White &amp; Black or African American &amp; American Indian or Alaska Native 18 White &amp; Black or African American &amp; Native Hawaiian or Other Pacific Islander 19 White &amp; Asian &amp; American Indian or Alaska Native 20 White &amp; Asian &amp; Native Hawaiian or Other Pacific Islander 21 White &amp; American Indian or Alaska Native &amp; Native Hawaiian or Other Pacific Islander 22 Black or African American &amp; Asian &amp; Native Hawaiian or Other Pacific Islander 23 Black or African American &amp; Asian &amp; American Indian or Alaska Native 24 Black or African American &amp; Native Hawaiian or Other Pacific Islander &amp; American Indian or Alaska Native 25 Asian &amp; Native Hawaiian or Other Pacific Islander &amp; American Indian or Alaska Native </p><p>Combination of Four Races26 White &amp; Black or African American &amp; Asian &amp; American Indian or Alaska Native 27 White &amp; Black or African American &amp; American Indian or Alaska Native &amp; Native Hawaiian or Other Pacific </p><p>Islander 28 White &amp; Asian &amp; American Indian or Alaska Native &amp; Native Hawaiian or Other Pacific Islander 29 White &amp; Black or African American or Alaska Native &amp; Native Hawaiian or Other Pacific Islander 30 Black or African American &amp; Asian &amp; American Indian or Alaska Native &amp; Native Hawaiian or Other Pacific </p><p>Islander Combination of Five Races 31 White &amp; Black or African American &amp; Asian &amp; American Indian or Alaska Native &amp; Native Hawaiian or Other Pacific Islander </p><p>Winchester Public Schools, 40 Samoset Road, Winchester, MA 01890 Phone: 781-721-7000 </p></li><li><p>Has your child previously attended Winchester Public Schools? Date withdrawn: _____________</p><p>List previous schools attended: _________________________________ Student has completed Grade:__________________________</p><p>Full Name DOBSchool GradeFull Name DOBSchool Grade</p><p>Full Name DOBSchool Grade</p><p>Immigrant status</p><p>Active duty members of the uniformed services, National Guard and Reserve on active duty orders</p><p>Proof of Residency and Occupancy: __________________________ Custody Papers (if applicable): _______________</p><p>Assigned to Grade: Teacher/Homeroom: Counselor:</p><p>Is your child eligible for McKinney-Vento?</p><p>Members or veterans who are medically discharged or retired for 1 year</p><p>The Commonwealth of Massachusetts requires us to collect the following: Students of Military Families are defined as children of: </p><p>Members who die on active duty</p><p>Is your child a member of a Military Family as defined above? </p><p>Proof of Birthdate? (i.e. Birth Certificate) ____________ initials of staff that reviewed Birthdate</p><p>Immunization Records received? ____________ initials of staff Start Date: ________________________</p><p>Previous School Transcripts received? ____________ initials of staff IEP, 504 PLAN _______________</p><p>If Yes, Country of origin? Is your child an Immigrant?</p><p>Student Services</p><p> Parent/Guardian Signature x ___________________________________________________________ Date: ____________</p><p>Section 504 of the Rehabilitation Act of 1973 is a national </p><p>law that protects qualified individuals from discrimination </p><p>based on their disability. </p><p>www.doe.mass.edu/sped/links/sec504</p><p>**Low Income Status: 00-Not Eligible 01-Eligible for free lunch 02-Eligible for reduced lunch</p><p>(Individualized Education Plan)</p><p>Are you sharing the housing of other persons due to </p><p>loss of housing, economic hardship, or similar </p><p>circumstances? </p><p>Statement of truth: By signing this Electronic Signature Acknowledgment, I agree that my electronic signature is the equivalent to my </p><p>handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. </p><p>By signing below, I agree that the information I submit in this document is true. </p><p>(I agree) electronic signature x ______________________________________________________________ Date: ____________ </p><p>The McKinney-Vento Act is a Federal Law that </p><p>ensures immediate enrollment and education </p><p>stability for Homeless Children and Youth. </p><p>http://www.doe.mass.edu/mv/</p><p> Military Family Status</p><p>For Office Use only</p><p>Federal definition: Immigration status is an indication of whether a student is considered to be an immigrant student under the Federal </p><p>Definition. 1. Not have been born in any state AND, 2. Not have completed 3 full academic years of school in any state.</p><p>Is your child eligible for a Section 504 plan? </p><p>Is your child eligible for an IEP program? </p><p>SIBLING INFORMATION: List name, date of birth, and school of other children in the family</p><p>Yes No</p><p>No</p><p>No</p><p>YesYesYes</p><p>Yes</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Winchester Public Schools, 40 Samoset Road, Winchester, MA 01890 Phone: 781-721-7000 March 2017</p><p>Y____ N____</p></li><li><p>Home Language Survey 2017-18 </p><p>Massachusetts Department of Elementary and Secondary Education regulations require that all schools determine the language(s) spoken in each students home in order to identify their specific language needs. This information is essential in order for schools to provide meaningful instruction for all students. If a language other than English is spoken in the home, the District is required to do further assessment of your child. Please help us meet this important requirement by answering the following questions. Thank you for your assistance. </p><p>Student Information </p><p>____________________________ ______________________ ___________________________ F M First Name Middle Name Last Name Gender </p><p>/ / / / Country of Birth Date of Birth (mm/dd/yyyy) Date first enrolled in ANY U.S. school (mm/dd/yyyy) </p><p>School Information </p><p>/ /20 ______ Start Date in New School (mm/dd/yyyy) Name of Former School and Town Current Grade </p><p>Questions for Parents/Guardians </p><p>What is the native language(s) of each parent/guardian? (circle one) </p><p> (mother / father / guardian) </p><p> (mother / father / guardian) </p><p>Which language(s) are spoken with your child? (include relatives -grandparents, uncles, aunts,etc. - and caregivers) </p><p> seldom / sometimes / often / always </p><p> seldom / sometimes / often / always</p><p>What language did your child first understand and speak? </p><p>_________________________________________ </p><p>Which language do you use most with your child? </p><p>_______________________________ </p><p>Which other languages does your child know? (circle all that apply) </p><p> speak / read / write </p><p> speak / read / write </p><p>Which languages does your child use? (circle one) </p><p> seldom / sometimes / often / always </p><p> seldom / sometimes / often / always </p><p>Will Parent/Guardian require written information from school in your native language? </p><p> Y N </p><p>Will Parent/Guardian require an interpreter/translator at Parent-Teacher meetings? </p><p>Y N </p><p>Parent/Guardian Signature: / /20 </p><p>Todays Date: (mm/dd/yyyy) </p></li><li><p>Winchester Public Schools Kindergarten Health and Immunization Information</p><p>The Massachusetts Department of Public Health and School Health Unit requires complete Health Records on every child before entering school.</p><p>THE REQUIREMENTS FOR CHILDREN ENTERING KINDERGARTEN IN SEPTEMBER ARE AS FOLLOWS:</p><p>*Complete up-to-date immunizations:</p><p>5 doses DTap/DTP4 doses Polio2 doses MMR3 doses Hepatitis B2 doses Varicella (or physician certified history of chickenpox disease)</p><p>* Results of Lead Screening* Updated physical exam form by Health Care Provider, within 12 months of the start of school* Health History</p><p>Please be aware that a copy of the physical exam with the above immunization is necessary before the first day of school in September. Your child will not be allowed to start school until all medical requirements are met.</p><p>If your child has a Life Threatening Allergy, please contact your school nurse to complete an Emergency Allergy Action Plan.</p><p>If your child has any medical conditions, such as asthma, epilepsy, diabetes, etc. please arrange to speak with the school nurse to discuss your child's history, medical needs, and plan of care for the upcoming school year. </p></li><li><p>Child'sFirstName Child'sMiddleName ForSchooluseonly</p><p>DateofBirth Gender Grade</p><p>State Zipcode Homeroom</p><p>Parent/Guardian:Pleaseindicatewhereparentscanbereachedduringtheday</p><p>Parent/Guardian1tocall Parent/Guardian2tocall Contact1 Contact2</p><p>Name: Name: Name: Name:</p><p>Relationship: Relationship: Relationship: Relationship:</p><p>Homephone: Homephone: Contactphone: Contactphone:</p><p>Work/Employerphone: Work/Employerphone:</p><p>Mobilephone#: Mobilephone#: Mobilephone#: Mobilephone#:</p><p>email: email: email: email:</p><p>MedicalInformationAtWMSandWHSonlyschoolnursesmayadministerAcetaminophenandIbuprofentostudentswhohaveparentalconsent.Adultstrength </p><p>Acetaminophen325mg (one ____ or two____ tablets).orIbuprofen200mg.(one ____ or two____tablets)willbegivenatthediscretionof</p><p>theschoolnurseforthefollowingconditions: Headache,menstrualcramps,dentalrelatedpain,musclesoreness.</p><p>Signature:________________________________________________ Date:____________________</p><p>Yes______No_______Initial_______ Notes:IgivepermissiontotheschoolnursetoadministerAcetaminophen. </p><p>IgivepermissiontotheschoolnursetoadministerIbuprofen. Yes______No_______Initial_______</p><p>DoesyourchildhaveHealthInsurance?Yes/No______ HealthInsuranceProvider:______________________ Notes:</p><p>DoesyourchildhaveDentalInsurance?Yes/No______ DentalInsuranceProvider:______________________</p><p>Igivepermissiontotheschoolnursetocontactmychild'sphysician.Yes/No________</p><p>EMERGENCYPERMISSION:IntheeventIcannotbereachedinanemergency,Igivepermissiontoschoolauthoritiestoprovideemergencymedicaltreatmentinthecaseofinjuryorillnessformychild</p><p>asconsiderednecessary.Iacceptresponsibilityforanyexpensesincurredinhandlingemergencycare.</p><p>Signature:____________________________________________________________ Date:______________</p><p>Winchester Public Schools Emergency Contact Information</p><p>PhysicianName:</p><p>PhysicianPhone:</p><p>DentistName:</p><p>Personstocontactifparent/guardiancannotbereached</p><p>Contact3</p><p>Name:</p><p>Relationship:</p><p>Contactphone...</p></li></ul>