Pre-Registration Part 1 (Revised January 2023)

Sudbury Public Schools: Student Pre-Registration

Please allocate 30 minutes to complete this registration. Use formal legal names for children and parents/guardians unless the form specifically asks for a nickname. Thank you!
Please do not fill out this form if your child is already enrolled in the Sudbury Public Schools. Kindergarten Registration for the 2023-2024 school year will open on February 1, 2023. Students eligible for Kindergarten next fall must be five years of age on or before 9/1/2023.

Preschool registration is always open.
Anticipated Start Date of School*

MonthDayYear
Date
Select the school district within which you reside:*

Josiah Haynes Elementary SchoolIsrael Loring Elementary SchoolGen. John Nixon Elementary SchoolPeter Noyes Elementary SchoolEphraim Curtis Middle SchoolUnknown
Student Information:
Student Name*

First NameMiddle NameLast NameSuffix
Nickname/Preferred Name
Entering Year:*
Gender*

MFN
Date of Birth*

MonthDayYear
Place of Birth*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade*
What grade are you registering for?
Please note: Preschool program description/schedule/location is subject to change according to district needs. Financial aid and a sliding scale for tuition is available based on family size and gross monthly income. After your application is submitted, you will be notified of your preschool session. PLEASE DRAG THE BOXES BELOW TO ARRANGE IN ORDER OF YOUR PRESCHOOL SESSION PREFERENCE:
Please click HERE for early childhood program definitions.
Please choose the option that best describes your child's early childhood program experience*

NO FORMAL EXPERIENCE: My child has been with a family member, a nanny/babysitter, or in unlicensed care. (01)FORMAL EXPERIENCE: Licensed Family Child Care for less than 20 hours per week. (05)FORMAL EXPERIENCE: Licensed Family Child Care for 20 or more hours per week. (06)FORMAL EXPERIENCE: Center Based Program for less than 20 hours per week. (07)FORMAL EXPERIENCE: Center Based Program for 20 or more hours per week. (08)FORMAL EXPERIENCE: BOTH a Licensed Family Child Care Provider AND a Center Based Program for less than 20 hours per week. (09)FORMAL EXPERIENCE: BOTH a Licensed Family Child Care Provider AND a Center Based Program for 20 or more hours per week. (10)INFORMAL: Coordinated Family and Community Engagement (CFCE) services funded by the Department of Early Education and Care. (02)INFORMAL: Parent Child Home Program (PCHP) services funded by the Department of Early Education and Care. (03)INFORMAL: BOTH Coordinated Family and Community Engagement (CFCE) AND Parent Child Home Program (PCHP) services funded by the Department of Early Education and Care. (04)
Please click HERE for early childhood program definitions.
Has your child ever attended the Sudbury Public Schools?*
Has your child ever been evaluated by the Sudbury Public Schools?*
Does your child have an Individualized Education Plan (IEP) or 504 Plan?*
If your child has an IEP or 504, please mail a copy along with any evaluation reports to Student Services at 40 Fairbank Road, Sudbury, MA 01776.
Language Spoken at Home*
Please enter just one language.
Student Race/Ethnicity (Please select all that apply.)*

WhiteBlack or African AmericanAsianAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderHispanic or Latino
Physical Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Current Mailing Address If Different From Above Address

Street Address

Street Address Line 2

CityState

Zip Code
Contact Information

(In Order of Importance) This information is used for parent communication.
1. Phone Number*
2. Phone Number
3. Phone Number
Primary E-mail*

Confirmation Email
Alternate E-mail

Confirmation Email
II. Parent/Guardian Information

No nicknames, please.
First Parent/Guardian Contact*

First NameMiddle NameLast Name
Relation To Student*
First Parent/Guardian Contact lives with Student*
First Parent/Guardian Contact has access to Student's records*
Phone 1

Area CodePhone Number
Phone 2

Area CodePhone Number
Phone 3

Area CodePhone Number
Email
example@example.com
Address If Different From Above

Street Address

Street Address Line 2

CityState

Zip Code
Second Parent/Guardian Contact (only skip this section if there is not a second legal guardian)

First NameMiddle NameLast Name
Relation To Student
Second Parent/Guardian Contact lives with Student
Second Parent/Guardian Contact has access to Student's records
Phone 1

Area CodePhone Number
Phone 2

Area CodePhone Number
Phone 3

Area CodePhone Number
Email
example@example.com
Address If Different From Above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
III. 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
Military Family Status - 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.
Emergency Information

Please name others who will assume responsibility/transportation in event we are unable to reach you. Please make them aware of their emergency status.
Emergency Contact Name*

First NameLast Name
Relation to Student*
Phone Number*

Area CodePhone Number
Emergency Contact Name*

First NameLast Name
Relation to Student*
Phone Number*

Area CodePhone Number
Student Permissions
Sudbury Technology Agreement
I allow my child to use the internet as outlined by the district Technology Agreement.*

YesNo
Sudbury Publication Policy
I allow my child’s image or work to be published as outlined by the district Publication Policy in school or community publications and/or websites.*

YesNo
I allow my family’s contact information to be used in the PTO (Parent Teacher Organization) Directory.*

YesNo
SERF: Sudbury Educational Resource Foundation
I allow my family’s contact information to be used by district-approved organizations such as SERF.*

YesNo
Sudbury Schoolology Information and Privacy Policy
I have read Schoology’s privacy policy and understand Sudbury’s use of my child’s name in this online system.*

YesNoMy child is NOT in 6th, 7th or 8th grade
Medicaid Consent Letter
I have reviewed the Medicaid Consent Letter and grant permission for the Sudbury Public Schools to obtain federal reimbursement for any qualifying services.*

YesNo
Student Medical Permissions

The school nurse has permission to administer the following over the counter medications:
Acetaminophen (Tylenol)*

YesNo
Ibuprofen (Advil)*

YesNo
Benadryl*

YesNo
Request to Transfer Records/Release Information

There are times when the information received raises questions that require clarification. This section would allow us to communicate with individuals needed as part of your child's registration. (ex. Pediatrician and/or Teachers)
I hereby consent to the RELEASE/TRANSFER of records and/or verbal exchange for the above mentioned student.*
Former School:

Name of School

Street Address Line

CityState / Province

Postal / Zip Code
School Phone Number

Area CodePhone Number
Fax Phone Number

Area CodePhone Number
Name of Physician

First NameLast Name
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physician Phone Number

Area CodePhone Number
Physician Fax Number

Area CodePhone Number
Electronic Signature of Parent/Legal Guardian
I agree that all the information above is accurate.*
Your Signature (Type full name above.)
Please click here for a copy of our Parent Handbook.

After submission, you will be redirected back to the Sudbury registration page. Please continue to complete the forms in Part One, and then proceed to Part Two. Thank you!
Should be Empty:

Sudbury Public Schools: Student Pre-Registration

Student Information:

Contact Information

II. Parent/Guardian Information

III. Family Information

Emergency Information

Student Permissions

Student Medical Permissions

Request to Transfer Records/Release Information

Electronic Signature of Parent/Legal Guardian