BRIDGEWATER-RAYNHAM REGIONAL SCHOOL DISTRICT

2017-2018 Kindergarten Registration Instructions - Procedure

STEP #1 Online preregistration:
Online preregistration will open on the District website at www.bridge-rayn.org. beginning Monday, January 23, 2017. Please follow the online directions, complete all necessary information and submit.
Please note, preregistration must be completed 24 hours prior to attending a registration session.

STEP #2 Collect required documents:
• Original Birth Certificate with raised seal
• Proof of residency 1 (one of the following)
o Executed mortgage signed & dated
o Quitclaim deed
o Lease signed & dated
o Notarized Letter (if applicable)
o Property Card (available on your town’s website)
• Proof of residency 2:
o Mass. Driver’s License with current address
• Proof of up-to-date immunizations, physical exam and lead test

STEP #3 Attend a registration session:
Registration will take place at the Bridgewater-Raynham Regional High School at 415 Center Street, Bridgewater. The District’s Centralized Registration will take place in the high school library on the second floor. It is not necessary for you to bring your child to registration. The dates and times for registration are as follows:

If your last name is A through J:
Monday February 13, 2017 5:30 P.M. - 7:30 P.M.

If your last name is K through R:
Thursday February 16, 2017 5:30 P.M. - 7:30 P.M.

If your last name is S through Z:
Tuesday February 28, 2017 5:30 P.M. - 7:30 P.M.

If you are not able to attend on your designated evening:
Thursday March 2, 2017 5:30 P.M. - 7:30 P.M.

If you have difficulty attending an evening registration, please contact Central Registration (508) 279-2140 ext. 139.

I understand I have to submit the documents listed above in order to complete registration. *

After reviewing the district school list above please choose the appropriate school for your child. *

What grade is your child entering? *

Basic Student Information

Student First Name *

Student Middle Name *

Student Last Name *

Student's Gender *

Student's Date of Birth (mm/dd/yyyy) *

MM

/

DD

/

YYYY

Student's Birthplace (Enter only the City or Town with no punctuation) *

Parent/Guardian's Mailing Name (ex: Mr and Mrs Gomez) *

Street Address, including Apartment # *

City, State, Zip *

Primary Phone Number *

Student resides with: *

IMMIGRATION STATUS: Is your child an immigrant based on the following definition? An immigrant student must not have been born in any state of the USA and not have completed 3 full academic years of school in any state to be considered any immigrant. *

Are there legal Custodial and/or Dismissal Restrictions for student? (If the answer to this question is YES, please provide the school with a copy of the legal document that outlines the court ordered restrictions in order for the School District to have the ability to comply.) *

Is your child currently on an IEP?(If YES, please bring a copy of your child's most recent signed IEP to registration night.)

Is your child currently on an 504?(If YES, please bring a copy of your child's most recent signed 504 to registration night.)

In order to provide better support to our military families, please inform us if a member of your family, immediate or extended, is serving in the military?

Is there a computer and internet access at home?

Race of Student

Dear Parent/Guardian:

Information below is required by the Massachusetts Department of Elementary & Secondary Education. Please check each appropriate answer, please list all races that apply.

Race *

Additional Race

Is the student either Hispanic or Latino? *

Prior School History

Please answer all questions completely.

What is the name of the last school your son/daughter attended? *

Address (Street, City State and Zip) *

Has this child ever been enrolled in a Massachusetts school? *

If YES, where:

Has this child ever been enrolled in Bridgewater-Raynham Regional School District? *

If YES, which B-R School:

Family

Please list any sibling(s).

List Child Name, Age, Grade and School (if applicable)

Parent/Guardian (1) Information

1 Relationship to Student

1 Lives with student? *

1 Salutation *

1 First Name *

1 Last Name *

1 Suffix

1 Street *

1 City *

1 State *

1 Zip Code *

1 Home Phone *

1 Cell Phone *

1 Employer

1 Office Phone

1 Office Phone Ext.

1 Email Address for this contact (contact(s) cannot share email address) *

Parent/Guardian Information (2)

2 Relationship to student

2 Lives with student?

2 Salutation

2 First Name

2 Last Name

2 Suffix

2 Street

2 City

2 State

2 Zip Code

2 Home Phone

2 Cell Phone

2 Employer

2 Office Phone

2 Office Ext

2 Email Address for this contact (contact(s) cannot share email address)

Medical

Immunization

Dear Parent/Guardians::

It is a state requirement that you provide the school district with a completed immunization history and a current physical examination. Please obtain, from your Physician, an updated immunization list and current physical examination form. Please note: A LEAD level must be documented on your child's physical exam form.

Please contact the school nurse if you wish to discuss any health or safety concerns for your child.

We look forward to welcoming your child to our school community.

Sincerely,
Marie C. Fahey R.N., MEd, N.C.S.N.
Nurse Leader
Health Services

Health Questions

Current Health Information

Is your child taking any regular medications? *

If yes, list the medications.

Has your child had any concussions, illnesses, injuries and/or surgeries since last school year? *

If yes, please list.

Diabeties? *

Taking Insulin? *

Severe Allegy? *

List allergies:

Asthma? *

Uses inhaler? *

Heart Condition? *

If yes, describe

History of Seizures? *

What type of seizure?

Date of Last Seizure?

MM

/

DD

/

YYYY

Hearing problems?

Which ear?

Hearing Aids?

Vision Problems? *

Yes

No

Glasses or contacts?

Other vision problems?

Please list any other Illness/Health issues:

Physician/Dentist Details

Please identify student's primary care physician and dentist.

Primary Care Physician's Name

Primary Care Physician's Phone Number

Date of last physical

MM

/

DD

/

YYYY

Dentist's Name

Dentist's Phone Number

Date of last dental exam

MM

/

DD

/

YYYY

Insurance

HEALTH and DENTAL INSURANCE INFORMATION: Please provide insurance.
The Commonwealth of Massachusetts now requires all residents to have health insurance. If you child is without health insurance or a health care provider (physician) please contact your school nurse for assistance. All communications are confidential.

Private Insurance Plan Name:

Private Insurance Subscriber ID#:

Private Insurance Policy Plan #:

Private Insurance Student Insurance ID #:

Medicaid/MassHealth Plan Name:

Medicaid/MassHealth Subscriber ID:

Medicaid/MassHealth Policy Plan #:

Medicaid/MassHealth Student Insurance ID#:

Dental Insurance Plan Name:

Dental Insurance Subscriber ID:

Dental Insurance Policy Plan #:

Dental Insurance Student Insurance ID#:

Student Transportation Details

In preparation for your child's entrance to school, the district needs to obtain information from you regarding transportation. If your child needs to be picked up or dropped off at a place other than your designated stop, please complete this page. Your child will be assigned to the route stop closest to the address you indicate. If no day care arrangements are submitted to the main office, your child's bus route will be assigned according to your home address. Due to the number of children on each bus, we can only do one pick-up and drop-off location for each child. The pick up location or drop off location must be the same for all five days.

Name of Daycare(if applicable)

Daycare Street Address(if applicable)

Daycare Phone Number(if applicable)

AM Pick up address (street, city)

PM Drop off address (street, city)

Emergency Contact Information

We will always contact the parent or legal guardian first in the event of an emergency. Who should we contact if the parent or legal guardian is NOT AVAILABLE?

Name of Emergency Contact 1 *

Emergency Contact 1 relationship to student *

Emergency Contact 1 Street, Town *

Emergency Contact 1 Home Phone *

Emergency Contact 1 Cell Phone *

Emergency Contact 1 Work Phone *

Name of Emergency Contact 2

Emergency Contact 2 relationship to student

Emergency Contact 2 Street, Town

Emergency Contact 2 Home Phone

Emergency Contact 2 Cell Phone

Emergency Contact 2 Work Phone

Final Registration Instructions-Ready to Submit

Thank you for completing the online registration for your son or daughter. PLEASE CLICK THE SUBMIT BUTTON AT THE BOTTOM OF THIS PAGE.

WHAT"S NEXT............................

STEP #2 Collect required documents:
• Original Birth Certificate with raised seal
• Proof of residency 1 (one of the following)
o Executed mortgage signed & dated
o Quitclaim deed
o Lease signed & dated
o Notarized Letter (if applicable)
o Property Card (available on your town’s website)
• Proof of residency 2:
o Mass. Driver’s License with current address
• Proof of up-to-date immunizations, physical exam and lead test

STEP #3 Attend a registration session:
Registration will take place at the Bridgewater-Raynham Regional High School at 415 Center Street, Bridgewater. The District’s Centralized Registration will take place in the high school library on the second floor. It is not necessary for you to bring your child to registration. The dates and times for registration are as follows:

If your last name is A through J: Monday February 13, 2017 5:30 P.M. - 7:30 P.M.
If your last name is K through R: Thursday February 16, 2017 5:30 P.M. - 7:30 P.M.
If your last name is S through Z: Tuesday February 28, 2017 5:30 P.M. - 7:30 P.M.
If you are not able to attend on your designated evening: Thursday March 2, 2017 5:30 P.M. - 7:30 P.M.
If you have difficulty attending an evening registration, please contact Central Registration (508) 279-2140 ext. 139.