Welcome to Wellesley Public Schools!...Wellesley Public Schools Department of Nursing Services Spring 2021 Dear Kindergarten Parent/Guardian, The Wellesley Public School Elementary

Revised 1/8/20

WELLESLEY PUBLIC SCHOOLS KINDERGARTEN REGISTRATION CHECKLIST

Welcome to Wellesley Public Schools!

Please present the following documents at time of registration District Registrar WPS Central Office, 40 Kingsbury Street, Wellesley, MA 02481 Phone: 781-446-6210 ext. 5600 Fax: 781-446-6207 Email: [email protected]

*** ALL DOCUMENTS must be submitted to complete registration. Your child will not be enrolled in the Wellesley Public Schools until all required documentation is received, reviewed, and processed.

Required documents provided by Wellesley Public Schools

_____ Authorization to Release School Records Form

_____ Registration Form for Admission

_____ Home Language Survey

_____ Student Health History Profile Form

_____ Emergency Contacts, Family & Medical Information Form

_____ Permissions for Media Publishing & Technology Use, & Student Handbook Agreement Form

_____ Student Directory Form

_____ Early Childhood Education Experience Survey

Required documents provided by the parent/legal guardian

_____ Immunization Record

_____ Parent/Guardian identification (i.e. MA Driver's license or passport)

_____ Proof of Residency (1 of 3 options)

• Current Property Tax Bill

• Fully Signed and Executed Purchase and Sale (P&S) Agreement(Occupancy date must be within 45 days of enrollment)

• Lease Agreement with children’s names listed in the lease

_____ Proof of Occupancy (1 of 2 options)

• Current Utility Bill

• Notarized Occupancy Statement in lieu of a Utility Bill

_____ Student’s Birth Certificate or Passport

If applicable: _____ Custody Papers/Caregiver Affidavit _____ English Language Learners Transcripts _____ IEP or Section 504 Plan

mailto:[email protected]

WELLESLEY PUBLIC SCHOOLS 40 Kingsbury Street • Wellesley • Massachusetts 02481

PH 781-446-6210 FAX 781-446-6207

Authorization to Release School Records

Student Name Grade /

Home Address

City State Zip Code /

Please send/or fax the student’s records at your earliest convenience to:

District Registrar, Wellesley Public Schools 40 Kingsbury Street Wellesley, MA 02481 Phone 781-446-6210 ext. 5600 Fax: 781-446-6207 Email: [email protected]

Please send all records pertinent to this student, including:

• Transcript information (includes identifying information, course titles, grades, ortheir equivalent and grade level completed)

• MCAS Scores

• Attendance Record

• Discipline Records and State Assigned Identification Number (SASID) ifapplicable

• Health Records

• English Language Learner Records

• 504 plan or IEP Special Education Records, inclusive of:o Evaluation Reportso Individual Education Program Documents (IEP’s)o Progress Reportso Other Special Education Records

□ Check here for authorization: I also authorize Wellesley Public Schools Special Education staff to speak

with my staff from my student’s previous school.

Name and complete address of school student is transferring from:

School Name:

Street Address:

City, State and Zip code:

Phone Number:___________________ Email:______________________

Signature of parent/guardian Date

For Office Use only:

Records request mailed on: Requested by:

Wellesley Public Schools Registration for Admission

Wellesley Public Schools • 40 Kingsbury Street • Wellesley MA 02481 • phone 781-446-6210

Rev 2/21 Registration for Admission Page 1 of 2

School:

To register for Kindergarten, your child must be 5 years old by August 31, 2021

Grade Entering (check one): □K □1 □2 □3 □4 □5 □6 □7 □8 □9 □10 □11 □12

Has your child previously attended Wellesley Public Schools? □ Yes □ NoYear:

Most Recent Grade Completed: Name of Last School Attended:

Student Information

First Name Middle Name Last Name

Date of Birth (mm/dd/yyyy)

Birth Place (City)

Home Address

City, State and Zip Code

City State Zip Code Home Phone

Gender

State Mandated Ethnicity & Race

Choose all that apply

⇨

Choose one

⇨

The Wellesley Public Schools is required by the State of Massachusetts to report each student’s ethnicity

and race using the State’s newly defined categories. If you have questions or concerns regarding this

request, please contact the Department of Education at 781-338-3000. Choose all that apply.

□ American Indian or Alaska Native □ Asian/Indian □ Black or African American

□ Caucasian (White) □ Native Hawaiian or other Pacific Islander

A person of Cuban, Mexican, Puerto Rican, South or Central American, or of other Spanish Culture or origin, regardless of race. Choose one.

□ Hispanic or Latino or □ Non-Hispanic or Latino

Primary Language Primary Language (other than English):

Immigration Status

Federal definition: Immigration status is an indication of whether a student is considered to be an immigrant student under the federal definition. 1. Not have been born in any state AND, 2. Not have completed 3 full academic years of school in any state.

Is your child an Immigrant? □ Yes □ No If Yes, Country of origin?

Wellesley Public Schools Registration for Admission


Rev 2/21 Registration for Admission Page 2 of 2

Student Services

Did your child have a Section 504 plan in his/her/their last district?

□ Yes □ NoSection 504 defines the rights of individuals with disabilities to participate in and have access to program benefits and https://www.doe.mass.edu/sped/links/sec504.html

Did your child have an Individualized Education Program (IEP) in his/her/their last district?

□ Yes* □ No(Individualized Education Program)

*If yes, please provide a copy of the most recent IEP withregistration.

Are you experiencing homelessness? □ Yes† □ No†If yes, the McKinney-Vento Act is a federal law that ensures immediate enrollment and education stability for homeless children and youth. Please contact the McKinney-Vento Liaison at Wellesley Public Schools at 781-446-6210 x5629 for additional information and assistance.

Are you sharing the housing of other persons due to loss of housing, economic hardship, or similar circumstances?

□ Yes □ No

Are you presently in the Foster Care system under DCF? □ Yes‡ □ No

‡If yes, please contact the Foster Care Liaison at Wellesley

Public Schools at 781-446-6210 x5629

Military Family Status

The Commonwealth of Massachusetts requires us to collect the following: (Please check the box that applies to your child.)

□ No, not a member of a military family. (00)

□ Yes, child of an active duty member. (01)

□ Yes, child of members or veterans who are medically discharged or retired for 1 year. (02)

□ Yes, child of a member who died on active duty. (03)

For more information on the Military Interstate Children's Compact Commission or MIC3 go to their website at https://mic3.net/ and contact the Military Liaison for Wellesley Public Schools at 781-446-6210 x5629.

Statement of Truth

By signing this Electronic Signature Acknowledgment, I agree that my electronic signature is the equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. By signing below, I agree that the information I submit in this document is true.

(I agree) Electronic Signature _ Date: _

Parent/Guardian Signature _ Date: _

http://mic3.net/

Wellesley Public Schools Home Language Survey - To be completed for all new students

Student's Name: __ Most Recent Grade Level: _

Student's Date of Birth: _ Student's Country of Birth: _

Primary Language of: Mother _ Father _Guardian _ Specify _

Relationship of Person Completing Survey: □ Mother □ Father □ Guardian □ Other Specify _

HOME LANGUAGE INFORMATION Massachusetts DESE regulations require that all schools determine the language(s) spoken in each student's 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.

English Other Other Languages

1. What language did your child first understand or speak? □ □

2. What language do you use to speak to your child most of the time? □ □

3. What languages does your child use to speak to you most of the time? □ □

4. What language does your child use to speak to brothers/sisters most of thetime? □ □

5. What language does your child use to speak to friends most of the time? □ □

Yes No Comments

6. Has your child attended school in the USA prior to today's enrollment?

Where? (State) _

What grades?(Pre K-12) _

□ □

If yes, was your child enrolled in classes for English Language Learners? □ □

7. Has your child learned to read English? □ □

8. Can an adult family member or extended family member speakEnglish? □ □

9. Does the parent/guardian request oral and/or written communication from theschool to be in a language other than English?

□ Oral □ Written

□ □

Signature of Person Completing Survey: _ Today’s Date: / / /

For office use only: Initial Assessment Date: _ Assessment tool: _ LEP Yes No

ELL Evaluator: _ Initial proficiency level: _

Program placement: (Check one) SEI Opt-out _

Home district school _ School assigned _ Entering Grade _


Rev 12/19

Wellesley Public SchoolsDepartment of Nursing Services

Spring 2021

Dear Kindergarten Parent/Guardian,

The Wellesley Public School Elementary Nurses would like to extend a warm welcome to you and your child. Due to the COVID-19 restrictions, we are unable to meet with you in person. As an alternative to direct face-to-face contact we ask that you send the following information to our office:

1. Copy of a physical examination dated after September 1, 20202. Verification of lead poisoning screening (usually found on physical examination report)3. Kindergarten vision screening including stereopsis (done by your pediatrician)4. Completed Student Health History (found in registration packet)5. Verification that your child has received all the required immunizations (see list below)

SCHOOL ENTRY IMMUNIZATION REQUIREMENTS FOR KINDERGARTEN:

DTaP / DTP 5 doses

Polio 4 doses* * Final polio dose must be given on or after four years of age and at least6 months after the previous dose

Hepatitis B 3 doses

MMR 2 doses

Varicella 2 doses** ** Varicella vaccine or “physician certified reliable history of chickenpox disease”

Note that the Massachusetts Department of Public Health has strict immunization guidelines for children entering the public school system. Please refer to the above list and plan accordingly with your pediatrician so that your child is able to begin the school year on time as no student may begin without the required immunizations.

Once all the information is reviewed by your school nurse, you will receive communication indicating that your child’s record is complete or it will identify if anything remains outstanding.

If you have any individual concerns regarding the kindergarten entrance requirements, please contact the nurse at your child’s school. Just as a reminder- physician offices tend to be very busy during the summer months and appointments fill up fast so plan accordingly. Please refer to WPS Nursing Services for additional information.

We look forward to working with you and your child and are available to answer any questions that you may have.

Sincerely, The Wellesley Public School Elementary Nurses

Chris Spolidoro, Bates School Nurse [email protected] Betsy Hindmarsh, Fiske School Nurse [email protected] Carol Sullivan, Hardy School Nurse [email protected] Caitlin Costello, Hunnewell School Nurse [email protected] Emma McMahon, Schofield School Nurse [email protected] Chris Babicz, Sprague School Nurse [email protected] Ann Warmington, Upham School Nurse [email protected]

https://sites.google.com/wellesleyps.org/nursing/








Wellesley Public Schools Student Health History Profile

Office Staff Only: School ______________

Entering Grade ____________

________________________ _________________ _____________ Child’s Last Name First Name Date of Birth Gender

Pre-Natal History – Check Yes or No

Full Term Birth □ Yes □ No Premature Birth □ Yes □ No

Adoption □ Yes □ No Confidential □ Yes □ No

Health History – if yes, to any, describe fully

Does your child have any medical conditions? Has your child received treatment for the following?

ADD/ADHD □ Yes □ No Eating/feeding □ Yes □ No

Developmental Delay □ Yes □ No Frequent nose bleeds □ Yes □ No

Diabetes □ Yes □ No Gastrointenstinal problems □ Yes □ No

Headaches/Migraines □ Yes □ No Hearing □ Yes □ No

(treated by MD) (more than 3 infections per year)

Heart Problems □ Yes □ No Tubes (ears) □ Yes □ No

Psychological/Behavioral concerns □ Yes □ No Hearing Aid □ Yes □ No

Seizures □ Yes □ No Mobility □ Yes □ No

Skin Conditions □ Yes □ No Sleep difficulties/nightmares □ Yes □ No

Urinary/Kidney problems □ Yes □ No Speech □ Yes □ No

Other _____________ Vision-wears glasses □ Yes □ No

Has your child ever been hospitalized? Medications Home School If yes, Age _______ Reason ______________________ List all medications your child is taking:

Does your child have: Medication __________________ □ □Asthma/Reactive Airway Disease □ Yes □ No Dose __________________ □ □ Allergy to: If yes, describe fully _____________________ Medication __________________ □ □Asthma Action Plan available □ Yes □ No Dose __________________ □ □Bee Sting □ Yes □ No ________________________________________________

Food □ Yes □ No Other important information

Medication □ Yes □ No Date of last Physical Examination: ____________________

Other □ Yes □ No Any recess, physical education or sport restriction:

History of anaphylactic reaction □ Yes □ No ________________________________________________

Treatment with epinephrine (Epi-Pen) □ Yes □ No ________________________________________________

Other treatment for these allergies □ Yes □ No Additional Information: ____________________________

Rev 12/15 Student Health History Page 1 of 2

Student/Family History

Please answer the following questions:

1.) Is there anyone besides the parent(s)/guardian(s) who provide care to your child?

2.) Do you have any religious or cultural practices that we should be aware of?

3.) Are there any traditions that your family observes that we should be aware of?

4.) Is there anything else we need to know about your child that would help us better care for him/her in the Health Office?

Parent/Guardian Signature: ___________________________________ Date: _____________________

The Nurse may share this information with non-nursing personnel on a “need to know” basis.

Rev 10/15 Student Health History Page 2 of 2

Contacts Page 1 of 2 Wellesley Public Schools • 40 Kingsbury Street • Wellesley MA 02481 • 781-446-6210 Rev 12/19

Wellesley Public Schools For School Use Only

Emergency Contacts, Family & Medical Information School: _

Student Information Homeroom: _

First Name Middle Last Name

Date of Birth Gender

Home Address

Sibling Information

Full Name Age

School Grade

Full Name Age

School Grade

Full Name Age

School Grade

Parent/Guardian 1 to call Parent/Guardian 2 to call

Name: Name:

Gender: □ Female □ Male □ Non-Binary Gender: □ Female □ Male □ Non-Binary

Employer: Employer:

Relationship: Relationship:

Phone to call 1st: _

□ Mobile □ Home □ Work

Phone to call 1st: _


Phone to call 2nd: (optional)

_


Phone to call 2nd: (optional)

_


Phone to call 3rd: (optional)

_


Phone to call 3rd: (optional)

_


Email: Email:

Address (if different than student)

Address (if different than student)

Persons to contact if parents/guardians cannot be reached

Contact 1 Contact 2 Contact 3

Name: Name: Name:

Relationship: Relationship: Relationship:

1st Phone: _


1st Phone: _


1st Phone: _


2nd Phone: _


2nd Phone: _


2nd Phone: _


Grade: _______

Contacts Page 2 of 2 Wellesley Public Schools • 40 Kingsbury Street • Wellesley MA 02481 • 781-446-6210 Rev 12/19

Wellesley Public Schools Emergency Contacts, Family & Medical Information

Medical Information

Physician Name: Phone:

Dentist Name: Phone:

Notes:

WMS & WHS Only

At WMS and WHS only school nurses may administer Acetaminophen and Ibuprofen to students who have parental

consent. Adult strength Acetaminophen 325mg. or Ibuprofen 200mg. (1-2 tab) will be given at the discretion of the

school nurse for the following conditions:

Headache, menstrual cramps, dental related pain, and muscle soreness.

I give permission to the school nurse to administer Acetaminophen. □ Yes □ No Initial _

I give permission to the school nurse to administer Ibuprofen. □ Yes □ No Initial _

Health Insurance

Does Student Have MassHealth? □ Yes □ No

If Yes: Supplemental MassHealth Questions:

I have read the MassHealth Form 28M/13 Mandated Parental Notice and Consent to AccessMassHealth (Medicaid) Benefits http://www.doe.mass.edu/sped/28mr/ □ Yes □ No

I give Wellesley Public Schools permission to share with MassHealth records and information concerning my child and their health-related services, if necessary. □ Yes □ No

Signature: _ Date: _

Does Student Have Other Health Insurance? □ Yes □ No

Health Insurance Provider:

Does Student Have Dental Insurance? □ Yes □ No

Permission to Contact Physician:

I give permission to the school nurse to contact my child’s physician. □ Yes □ No

Emergency Permission

In the event I cannot be reached in an emergency, I give permission to school authorities to provide emergency medical treatment in the case of injury or illness for my child as considered necessary. I accept responsibility for any expenses incurred in handling emergency care.

Signature: Date:

http://www.doe.mass.edu/sped/28mr/

Wellesley Public Schools Permissions for Media Publishing & Technology Use, and Student Handbook Agreement

Student Name: _

Permission for Media Publishing

The purpose of this form is to obtain a release for your child to be interviewed and/or photographed during the course of

the year. In publicizing special events and programs that take place within our schools during the year, there may be

times when the school district will want to highlight a student’s or school’s accomplishments in media publications such

as:

● Student Newspaper (print and online versions)

● Wellesley School District Website and official social media accounts

● PTO websites and official social media accounts

● School Yearbook, Photo book, Photo directory

● News Articles (e.g. Wellesley Townsman, Boston Globe, Boston Television News)● Local, state and federal agencies and museums associated with Wellesley Public Schools projects.

Permission for Student to be Interviewed:

Permission for student to be interviewed at school for media publications, when this media visit

has been authorized by the school administration.

□ Yes □ No

Permission to Use Student Picture:*

Permission for my child’s picture (photograph, video, or multimedia project) to be published in

media publications.

□ Yes □ No

Publishing of Student Work:*

Permission for my child’s work to be published in media publications. □ Yes □ No

Yearbook:*

Permission for my child’s picture and work to be published in the school’s yearbook, photo book or

photo directory.

□ Yes □ No

* Please note: Athletic competitions, school plays, concerts or other activities open to the public are in the public domain. Students may

be photographed or videotaped at these events without expressed permission.

Permission for Student to use Educational Software:

I give permission for my child to have access to educational software that includes, but is not limited to:

● Google Apps for Education (aka G Suite) including Google Classroom, Drive, Docs, Calendar, Mail (MS & HS)

through Wellesley Public School District's WPSraiders.org domain

● Keyboarding without Tears (Upper Elementary)

● Dreambox (Elementary)

● Kids A-Z (Elementary)

● Canvas (HS)

● Pearson Realize (District-wide)

● Seesaw (grades PK-2)

For more information about how WPS students use educational software visit

https://wellesleyps.org/technology/wps-educational-software-permission/

□ Yes,

I agree

Student Handbook (Please read through with your child):

My child and I have read the Student Handbook and we agree to abide by the policies and guidelines

contained in the handbook. https://wellesleyps.org/students-families/handbooks/

□ Yes,

I agree

Please sign and date below:

Signature _ Date _

Wellesley Public Schools • 40 Kingsbury Street • Wellesley MA 02481 • phone 781-446-6210 Updated 1/21

Wellesley Public Schools Student Directory

Diretory Page 1 of 2 Wellesley Public Schools • 40 Kingsbury Street • Wellesley MA 02481 • 781-446-6210 Updated 12/19

Welcome to Wellesley Public Schools! We are excited to have you join our school community! The Parent Teacher Organizations (PTOs)

are dynamic organizations at our schools. Among many wonderful programs and services they provide, the PTOs deliver a weekly

newsletter and publish a Family Directory containing contact information for our families to use. If you would like to be included in

these great communication tools, you will need to provide your contact information.

Student Directory Information

Student's Name (First Last):

Preferred First Name (if applicable): Grade:

Street Address

City State Zip Code

Parent/Guardian 1 Name:

Mobile Phone Home Phone

Email

Parent/Guardian 2 Name:

Mobile Phone Home Phone

Email

Second Address - Joint Physical Custody (if applicable)

Street Address:

City State Zip Code:

Student Directory Information Release

Student Directory information is shared with district approved parent and community partners, such as PTOs and the Wellesley

Education Foundation (WEF), for the advancement of our programs and communications among our families and educational

community.

◯ Yes, share my child's information with district approved parent and community partners (opt-in)

◯ No, do not share my child's information with district approved parent and community partners (opt-out). I understand that by

opting out I will not be included in the School PTO’s Family Directory and I will not receive the PTO weekly emails.

Third Party Information Release

Release of student directory information to Third Parties other than Wellesley approved community and partner organizations:

I give permission for my child's information to be given to third parties, outside of Wellesley approved partner organizations. See the

Family Educational Rights and Privacy Act (FERPA) Notification of Rights information on the following page and the Legal Notices

section of our website for more information:

https://wellesleyps.org/legal-notices/notification-of-rights-under-ferpa-for-elementary-and-secondary-schools/

◯ Yes, share my child's information with third parties (opt-in)

◯ No, do not share my child's information with third parties (opt-out)

Please sign and date below:

Signature _ Date _

Wellesley Public Schools Student Directory

Directory Page 2 of 2 Wellesley Public Schools • 40 Kingsbury Street • Wellesley MA 02481 • 781-446-6210 Updated 12/19

Family Educational Rights and Privacy Act (FERPA)

The Wellesley Public Schools is committed to ensuring the information privacy and confidentiality of student

records under their supervision in accordance with the provisions of 603 CMR 23.00 and M.G.L. c. 71, § 34H,

and the Family Educational Rights and Privacy Act (FERPA).

District approved parent and community partners such as our Parent, Teacher Organizations (PTOs), Wellesley

Education Foundation (WEF), etc. request contact information for our families to produce school directories,

which we recognize are a valued resource for our families. In accordance with our Student Records Policy

(JRA, JRA-R) and the Family Educational Rights and Privacy Act (FERPA), parents have an annual opportunity to

customize/opt out of the information released through the PowerSchool Parent Portal, or by notifying the

school directly in writing. Please note that parent organizations share directory information with the

understanding that this information will not be used for commercial, political, or other third party uses, and are

educated as to the importance of information privacy and confidentiality. Families who opt out of this

communication tool may not receive access to the directories.

See the Family Educational Rights and Privacy Act (FERPA) Notification of Rights information on the Legal

Notices section of our website for more information:

https://wellesleyps.org/legal-notices/notification-of-rights-under-ferpa-for-elementary-and-secondary-schools/

Wellesley Public Schools Early Childhood Education Experience Survey

Please check next to the option that best describes your child’s preschool experience in the school year prior to entering

Kindergarten. Select one option only, and indicate hours where applicable. Thank you!

Name of Child: Date of Birth:

❏ My child did not have any formal early childhood program experience

❏ My child did not have formal early childhood program experience but participated in Coordinated Family and

Community Engagement (CFCE) services.

❏ My child did not have formal early childhood program experience but participated in Parent Child Home

Program (PCHP) services.

❏ My child did not have formal early childhood program experience but participated in BOTH Coordinated Family

and Community Engagement (CFCE) AND Parent Child Home Program (PCHP) services.

❏ My child attended a Licensed Family Child Care Provider (indicate hours below)

for less than 20 hours per week

for 20+ hours per week

❏ My child attended a Center Based Program (indicate hours below)



❏ My child attended BOTH a Licensed Family Child Care Provider AND a Center Based Program

(indicate hours below)



Definitions:

Coordinated Family and Community Engagement (CFCE) Services: Locally based programs serving families with

children birth through school age (e.g. parent/child playgroups, parent-child activities).

Parent Child Home Program (PCHP): Home visiting model program funded through the Department of Early

Education and Care.

Licensed Family Childcare: Refers to EEC licensed child care in a group setting in a home. It may include care in the

home of a family member, if the provider is both a relative and an EEC licensed child care provider providing care to

children from multiple families.

Center-Based Care: Refers to care for children in a group setting, including public and private preschools, Head Start,

day care centers, and integrated public preschools.


Wellesley Public Schools

Department of Transportation

For information on Bus Transportation please contact our

Director of Transportation,

Deane McGoldrick at

781-446-6210 Ext. 5614

(you may leave a message and he will return your call)

Or check out our web-site at link below

https://www.wellesleyps.org/students-families/transportation/

https://www.wellesleyps.org/students-families/transportation/