LS Enrollment Form

Lincoln-Sudbury Regional High School 2021-2022 Enrollment Form
today’s date
The following enrollment form collects information and documents necessary to enroll at Lincoln-Sudbury Regional High School. By entering your name and email address into this form, you will be able to return to the document again to complete any unanswered questions before you submit this form. Where indicated, please upload the required enrollment documents or mail them to:

Registrar
Lincoln-Sudbury Regional High School
390 Lincoln Road
Sudbury, MA 01776

Note: completion of this form does not guarantee enrollment at Lincoln-Sudbury. After all the required forms and documents have been submitted, you will be contacted to set up an appointment to meet with a Guidance Counselor. Students along with parent(s)/guardian(s) must attend a registration appointment with a Guidance Counselor. Students are not considered enrolled at Lincoln-Sudbury Regional High School until they have met with a Guidance Counselor.
Parent/Guardian Email *
Parent/Guardian Contact Phone #

Family Information

Please know that this information will be used to match a new student to existing records in the student information system. No nicknames, please.
How many siblings does the student have
Sibling Information

1st Parent/Guardian Contact Information
Parent/Guardian Name

First Name Last Name
Address (If different from student address)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Email *
example@example.com
Alternate Email
example@example.com
Employer
Employer Address
Please list phone numbers in order of importance.
1. Phone Number
Please enter a valid phone number.
2. Phone Number
Please enter a valid phone number.
3. Phone Number
Please enter a valid phone number.
Relationship to Student
Does this guardian live with student?

Yes No
Does this guardian have portal access:

Yes No
Does this guardian have right to dismiss/receive student:

Yes No

2nd Parent/Guardian Contact Information
Parent/Guardian Name

First Name Last Name
Address (if different from student address)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Email
example@example.com
Alternate Email
example@example.com
Employer
Employer Address
Please list phone number in order of importance.
1. Phone Number
Please enter a valid phone number.
2. Phone Number
Please enter a valid phone number.
3. Phone Number
Please enter a valid phone number.
Relationship to Student
Does this guardian live with student?

Yes No
Does this guardian have portal access:

Yes No
Does this guardian have right to dismiss/receive student:

Yes No

Emergency Contact

Person to notify in case of an emergency/illness and parent(s)/guardian(s) cannot be reached
Name

First Name Last Name
Relationship to student
1. Phone Number
Please enter a valid phone number.
2. Phone Number
Please enter a valid phone number.

Military Recruiter Release:
Under Section 9528 of the ESEA (Elementary and Secondary Education Act) AND FERPA, schools receiving federal funds must provide Military Recruiters with Student’s Names, Address and Telephone numbers.
Parent(s)/Guardian(s) have the right to opt-out of sharing this information with Military Recruiters.
Those wishing to opt-out of sharing this information must check the box below. This one time opt-out request will remain in effect while your child is a student at Lincoln-Sudbury.

I request that my student NOT have their name, address and telephone listing released to the Armed Forces.
Military Family Status: The Department of Education collects information about the military family status of students. This information is used by the Department of Education to determine whether students are covered by the Interstate Compact on Educational Opportunity for Military Children (http://mic3.net). The Compact, which Massachusetts joined in May 2013 as part of the VALOR Act, aims to make the transition easier for mobile children in military families in areas such as enrollment, assessment, graduation etc. Please check the following boxes if your student lives in the household of:

Full-time active duty members in the uniformed service of the United States, including members of the National Guard and Reserve on active duty orders pursuant to 10 U.S.C. Section 1209 and 1211. Members or veterans of the uniformed services who are severely injured and medically discharged or retired for a period of one year after medical discharge or retirement. Members of the uniformed services who die on active duty or as a result of injuries sustained on active duty for a period of one year after death. Does Not Apply
Student Media Release:
Photographs and video images of students at Lincoln-Sudbury Regional High School are routinely created for the purpose of sharing student achievements and celebrating educational programs with the community. Photographs are sometimes submitted to area newspapers, used in school publications, posted on our district/school websites, and/or shared with the Lincoln-Sudbury Parents Organization (LSPO). Photos of your child may be used on the website, student newspaper, yearbook and/or local media. Any student whose parent/guardian does not want their child's picture taken, including in group settings, is advised to complete this opt-out form and ask your student to step out of any group picture being taken.
Federal and state law allows schools to disclose this type of information without consent but parents and eligible students have the right to “opt-out”. (This right does not apply to occasions in which the school is required to provide an image for legal or safety reasons.)
To revoke the right of Lincoln-Sudbury Regional High School to use or publicly display your child's image, video or audio clip on the LSRHS website or other official or local publications, please sign and return this form to the Main Office at Lincoln-Sudbury.

I request that my student NOT have their image, video or audio clip be released or displayed on the district web site or other official media as described above.

Required Forms and Documents Section
Note: Due to the realities of homelessness and mobility, students in transition may not have enrollment documents available. Nonetheless, the district will immediately enroll any child or youth in transition. Enrollment for families in transition may not be denied or delayed due to lack of any document normally required for enrollment. Families/students experiencing homelessness or any transition, including unaccompanied youth, should contact the Registrar at 978-443-9961 X2334
Forms to complete and upload:
Please print and complete these forms and upload the completed form in one of these formats:

pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif. Documents can also be emailed to Lincoln-Sudbury registrar@lsrhs.net or hardcopy mailed to: Registrar, Lincoln-Sudbury Regional High School, 390 Lincoln Road, Sudbury, MA 01776
2021-2022 Health and Emergency Form

Request for Student Records Form

Massachusetts Department of Education Language Survey Form (select your language)

MIAA FORM 200 - this form is only for High School Athletes tranferring to Lincoln-Sudbury from another high school.
Upload completed Health/Emergency Information Form

Browse Files
Health/Emergency Cancel of
I am going to mail the Health and Emergency Information Form.
Upload completed Request for Student Records Form

Browse Files
Request for Records Cancel of
I am going to mail the Request for Student Records Form
Upload Completed Language Survey Form

Browse Files
Language Survey Cancel of
I am going to mail the Language Survey Form
Upload athletics MIAA Form 200 - for students transferring from other high schools,

Browse Files
Form 200 Cancel of
I am going to mail the MIAA Form 200

Documents to Upload:
Proof of Occupancy

Browse Files
Must be a current utility bill or notarized occupancy statement Cancel of
I am going to mail proof of occupancy.
Proof of Residency

Browse Files
Must be either a tax bill or a fully signed and executed Purchase and Sale (P&S) Agreement can be used, provided the occupancy date occurs before a student can be enrolled in the district Cancel of
I am going to mail proof of residency
Parent/Guardian identification

Browse Files
i.e. copy of MA Driver's license or passport Cancel of
I am going to mail parent/guardian identification.
Student Birth Certificate or Visa/Passport

Browse Files
Copy of Birth Cert or Passport Cancel of
I am going to mail a birth certificate or visa/passport documents.
Current Physical with Immunization Record:

Browse Files
Student Physical Cancel of
I am going to mail the Physical/Immunization information
Transcript and/or Grade Reports:

Browse Files
Transcript/Grades Cancel of
I am going to mail the Transcript/Grade reports
Custody/Legal Guardian Official Documents

Browse Files
if applicable Cancel of
I am going to mail custody/legal guardian documents. Does not apply
NOTE: If your child is on an IEP or a 504, please be prepared to bring those documents and any recent testing to the Counselor enrollment meeting. You can also send them to the registrar@lsrhs.net at any time.

Your signature is the final step in this enrollment document.

Do not click the "Submit Form" button if you have not completed the form and/or have documents to upload.

If you have completed this document, thank you. This information will be reviewed and we will be contacting you with any further steps and to set up a Guidance counselor appointment in the near future.

We look forward to welcoming your student to the Lincoln-Sudbury Regional School District.

Thank you

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.
Signature

Name and Date Clear
Should be Empty:

Lincoln-Sudbury Regional High School 2021-2022 Enrollment Form

Student Information

Family Information

1st Parent/Guardian Contact Information

Please list phone numbers in order of importance.

2nd Parent/Guardian Contact Information

Please list phone number in order of importance.

Emergency Contact

Please print and complete these forms and upload the completed form in one of these formats: