MEDWAY PUBLIC SCHOOLS

PRESCHOOL PACKET

In this packet you will find:

● Cover letter with Registration Checklist ● Application for Preschool ● Agreement for Preschool Tuition ● Registration Form ● Medway Student Health History ● Home Language Survey ● School Calendar ● School Hours and Addresses ● Communication from School Nurse ● Free and Reduced Lunch Application ● Vaccination Exempt Form

MEDWAY PUBLIC SCHOOLS REGISTRATION CHECKLIST

Welcome to Medway Public Schools! Please complete New Student Registration Packet which includes: ● Registration Form ● Emergency Information Form ● Health History Form ● Home Language Survey

In addition to the forms above, the following documents are required: ● Proof of residency: ○ Utility bill ○ Signed Purchase and Sale (occupancy must take place within sixty (60) days) ○ Current Tax Bill ● Birth Certificate ● Copy of most recent physical exam - should be dated after January 1 of year of registration. ● An immunization record from the physician ● A copy of current 504/IEP plan (if applicable) ● Legal court documentation of guardianship (if applicable)- If divorced or separated, you will need to show legal or official court documentation indicating that you are the custodial parent and have physical custody of your child. ● Free and Reduced Price School Meals Application (if applicable)

Please note that all of the above must be presented to complete the registration process: NO child will be able to register without all documentation.

All completed documents should be delivered at time of registration: Registration will be held in the Library of the McGovern Elementary School on Lovering Street Tuesday, February 27, 2018 from 3:30 p.m. to 6:00 p.m. Saturday, March 3, 2018 from 9:00 a.m. to 12:00 p.m.

MEDWAY PUBLIC SCHOOLS Medway, MA 02053 TUITION-FUNDED INTEGRATED PRESCHOOL PROGRAM 2018-2019

APPLICATION

Please enter my child's name in the full or half day, tuition-funded integrated preschool program. I understand this program requires a tuition payment due each month prior to the month of attendance. Please hold onto this form and deposit until May 1

Please note: ● Child must be 3 years old to be eligible; or 4 years old by August 31, 2018 to be eligible for consideration of Full Day. ● Child must be properly registered through the Superintendent’s Office. ● Faxes will not be accepted. ● A non-refundable payment for the full-day integrated preschool will be du​ e in the amoun​ t of $470.00 after May 1, 2018. ● A non-refundable payment for the half-day integrated preschool will be du​ e in the amoun​ t of $475.00 after May 1, 2018. ● Signed Agreement Form for Full-Day or Half Day Tuition-Funded Integrated Preschool must accompany this application.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Please print: ​ Date: ______

Child's Name: ______

Parent/Guardian Name: ______

Address: ______

Home Telephone: ______

Work Telephone: ______

Cell Phone: ______

Email: ______

______Parent/Guardian Signature

Make check payable to: Medway Public Schools Return this form, non-refundable payment of $470.00 for full-day integrated preschool and $475.00 for the half-day integrated preschool. Agreement Form after May 1, 2018 Medway Pub​ lic Schools Attn: Business Office 45 Holliston Street Medway, MA 02053

Medway Public Schools Medway, MA 02053 AGREEMENT for FULL or HALF DAY TUITION-FUNDED INTEGRATED PRESCHOOL 2018-2019

I.Understanding of My Payment Obligation ​ In order for my child to be enrolled in the full-day integrated preschool, I hereby agree to pay the annual tuition of ​ ​ ​ $6,550.00 payable by an initial deposit of $470.00 by May 18, 2018, with the balance due in eight (8) monthly ​ ​ ​ installments of $760.00 submitted by the 15th of each month prior to the month of attendance; the first installment ​ th ​ ​ is due on August 13 ,​ 2018. ​

In order for my child to be enrolled in the half-day integrated preschool, I hereby agree to pay the annual tuition of ​ ​ ​ ​ $3,275.00 payable by an initial deposit of $475.00 by May 18, 2018, with the balance due in eight (8) monthly ​ ​ ​ installments of $350.00 submitted by the 15th of each month prior to the month of attendance; the first installment ​ th ​ ​ is due on August 13 ,​ 2018. ​

I understand that if I fail to make a tuition payment and my account is in arrears two payments, (60) sixty days, my child will automatically lose his/her seat. Additionally, I understand that the tuition fee will not be modified to reflect any absences incurred by my child during the course of the school year.

I understand that if payment for this program is creating a financial hardship I will notify the superintendent’s office immediately and apply for a waiver or reduction in fee based upon school committee policy and the free and reduced lunch program guidelines. However, in the event that I am not eligible for a waiver or reduction in fee that I will continue to make payments or my child will be removed from the program.

I understand that should I remove my child from the program, or the school department removes my child from the program due to non payment, I will still be responsible for tuition pro-rated for the time my child participated in the program.

Payments must be in the form of a check or money order made payable to “Medway Public Schools.” Checks should ​ ​ be delivered or mailed to the Business Office, 45 Holliston Street, Medway, MA 02053. The Town Treasurer will assess a $25.00 charge for checks returned for insufficient funds.

II. Understanding of My Child’s Participation in the Program I understand that my child’s full or half-day integrated preschool seat is not transferable.

I understand the full or half-day integrated preschool will not be considered an academically accelerated program, nor will the teacher follow an advanced grade level curriculum.

I understand the tuition-funded, full or half-day integrated preschool is for regular education students and that several special education students will be assigned to each full or half-day integrated preschool section by the school.

I understand my child is expected to follow all reasonable rules and expectations for student conduct; inappropriate behavior may result in exclusion from the tuition-funded kindergarten program.

III. Acknowledgement I have read and understand the above terms and conditions under which my child, (print student’s name) ______, is admitted to the tuition-funded, ​ full or half-day integrated preschool program, and I hereby agree to these terms and conditions. ​ ​

______(Date) Parent/Guardian Signature

______Print Parent/Guardian Name

Please return this completed form at the time of registration.

Medway Public Schools Medway, MA NEW STUDENT REGISTRATION Please print: Date: ______School Year: ______Grade Entering: ______

PART A Student’s Full Name: ______(Last name) (First name) (Middle name as it appears on Birth Certificate) Home Address: ______(Street) (City/town) (Zip) Home Phone: ______Sex: Male Female Date of Birth: ______Birth City/State: ______

Previous School Information

Last School Attended: ______Grade: ______

City/Town: ______State: ______Please check any additional services the student was receiving: Student has an Individual Education Plan Student has a 504 Plan Student was receiving LEP Services Student was receiving Title I Services

Part B Parent/Guardian #1: ______

Address if different: ______(Street) (City/town) (Zip) Please Provide all of the below information and check box to indicate primary contact number during school hours Home Phone ______Work Phone ______Cell Phone ______Email ______Parent/Guardian #2: ______Address if different: ______(Street) (City/town) (Zip) Please Provide all of the below information and check box to indicate primary contact number during school hours Home Phone ______Work Phone ______Cell Phone ______Email ______

Part C With whom does student reside? Both Parents Mother Father Guardian Other Who has legal custody of this student? Both Parents Mother Father Guardian Other Is there any other legal information that the school should be aware of? Yes No If yes, documentation is required. Is anyone restricted from contacting this child? Yes No If yes, documentation is required. Has this student ever attended Medway Public Schools? Yes No Other Massachusetts Schools? Yes No (OVER) Is student a state ward/foster child? Yes No Is student a School Choice Student approved by the Superintendent? Yes No Part D – In case of accident, illness, emergency or early dismissal and parent/guardian cannot be reached:

Name: ______Relationship: ______

Phone: ______

Name: ______Relationship: ______

Phone: ______If applicable: If both parents work, who is responsible for student after school? Name: ______Relationship: ______

Address: ______Phone: ______

Please list siblings who attend Medway Public Schools: Name: ______Grade: ______Name: ______Grade: ______

Part E – Military Family Status – Required information ​ Is the student a child of:

● An active duty member of the uniformed services, National Guard, Or Reserve on active duty? Yes No ● Members or veterans who are medically discharged or retired within the last year? Yes No Member(s) who have died on active duty? Yes No Part F – REQUIRED Information: ​ The district is required to provide this information to the state and federal agencies for statistical purpose to demonstrate compliance with the 1964 Civil Rights Act.

Please select from each of the categories: Ethnicity (select only one) Race (select one or more) Hispanic or Latino American Indian or Alaskan Native Not Hispanic or Latino Asian Black or African American Native Hawaiian or Other Pacific Islander White

I hereby certify the information to be true and correct. ______Date Parent/Guardian Signature

______Parent/Guardian PRINT NAME

For office use only LASID # ______SASID # ______New student Registration FORMS Rev 12/15/17 MEDWAY STUDENT HEALTH HISTORY

School ______Grade ______

______Child’s last name First Name Date of Birth Sex

Birth History: Has your child had any of the following? ​ Full term (over 37 weeks) ______Serious accident __yes __no Premature (# of weeks) ______Operations __yes __no Early Intervention: __yes __no Fractured bones __yes __no Developmental History: any significant developmental Serious head injury/concussion __yes __no ​ delays (crawling, walking, talking, toileting)? Hospitalization __yes __no ______Please give details of above: ______Does your child have? ______ADD/ADHD __yes __no Does your child have an allergy to? ​ Asthma/Reactive Airway disease __yes __no Bee stings __yes __no Bleeding Disorder __yes __no Food __yes __no Bone or joint disease __yes __no Medication __yes __no Dental issues __yes __no Other __yes __no Diabetes __yes __no History of anaphylactic reaction __yes __no Dietary restrictions __yes __no Date of last episode:______Headaches/Migraines __yes __no Treatment with epinephrine (EpiPen) __yes __no Heart Condition __yes __no Other treatments for these allergies __yes __no Scoliosis __yes __no Please give details of above:______Febrile Seizures __yes __no ______Last seizure______Seizure Disorder __yes __no Medications: Last seizure______Daily Medication: ______Skin Conditions/Eczema __yes __no ______Stomach/Bowel problems __yes __no As needed medication: ______Tuberculosis __yes __no ______Urinary/Kidney problems __yes __no ______Other including medical, behavioral Can your child participate in all school activities? __yes ​ or mental health issues __yes __no __no Please give details of the above conditions: If “no” please explain:______​ ______Any additional information you would like to share:______Has your child received treatment for the following? ______dental/orthodontic __yes __no ______eating/feeding issues __yes __no ______frequent colds/strep throat __yes __no May we share this information with school staff? frequent nosebleeds __yes __no __yes __no frequent ear infections __yes __no ear tubes __yes __no ______hearing/hearing aids __yes __no Health Care Provider Phone mobility __yes __no ______sleep difficulties/ nightmares __yes __no Dentist Phone ​ speech __yes __no ______vision/ glasses/ contacts __yes __no Health Insurance Provider Please give details of the above: ______​ ______Parent/ Guardian signature Date ______Parent/ Guardian phone 1/2016; revised 3/2017, 11/2017 PM

Home Language Survey Massachusetts Department of Elementary and Secondary Education 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.

Student Information

Gender F M

Country of Birth Date of Birth (mm/dd/yyyy) Date first enrolled in ANY U.S. School (mm/dd/yyyy) ​ ​ School Information

/ /20

(mm/dd/yyyy) Start Date in New School Name of Former School and Town Current Grade ​

Questions for Parents/Guardians

Which language(s) are spoken with your child? What is the primary language used in the home, regardless (include relatives: grandparents, uncles, aunts, etc. - and ​ ​ ​ of the language spoken by the student? caregivers)

______seldom / sometimes / often / always

______seldom / sometimes / often / always

What language did your child first understand and speak? Which language do you use most with your child?

______

Which languages does your child use? (circle one)

How many years has the student been in U.S. Schools? (not ______including pre-kindergarten) seldom / sometimes / often / always

______seldom / sometimes / often / always

Will you require written information from school in your Will you require an interpreter/translator at Parent-Teacher meetings? native language? Y N Y N

If yes, what language? ______If yes, what language? ______

Parent/Guardian Signature: X / /20 Date: (mm/dd/yyyy) ​

11-2017

School Hours and Addresses

McGovern Elementary School: 9 Lovering Street, Medway, MA 02053 Phone (508) 533-3243

Pre-Kindergarten at McGovern Elementary School ​ 8:55 a.m. to 11:15 a.m. or 12:10 p.m. to 2:30 p.m. Full Day 8:55 a.m. - 2:30 p.m. ​

McGovern (Full day Kindergarten and 1st Grade) Student instructional day: 8:45 a.m. to 3:00 p.m.

Burke-Memorial Elementary School: Grades 2-4 16 Cassidy Lane, Medway, MA 02053 - Phone (508) 533-3266 Student instructional day: 8:15 a.m. to 2:30 p.m.

Medway Middle School: Grades 5-8 45 Holliston Street, Medway, MA 02053 - Phone (508) 533-3230 Student instructional day 7:25 a.m. to 1:58 p.m.

Medway High School: Grades 9-12 88 Summer Street, Medway, MA 02053 - Phone (508) 533-3227 Student instructional day 8:04 a.m. to 2:31 p.m.

Times for Early Release Days School Day:

McGovern School: 8:45 a.m. to 12:00 noon Burke- Memorial School 8:15 a.m. to 11:30 a.m. Middle School 7:25 a.m. to 11:02 p.m. High School 8:04 a.m. to 11:34 a.m.

MEDI: ​ GRADES K-4 * PHONE: 508-533-7395 * Burke Memorial Morning - 7:00 A.M -8:35/8:45 A.M. Afternoon - 2:30/3:00 P.M- 6:00 P.M. GRADES 5-6 * PHONE: 508-321-4782 * Medway Middle Morning - 7:00 A.M- 7:25 A.M. Afternoon - 1:58 P.M.- 6:00 P.M.

Medway Public School School Nurse Health Services

Dear Incoming Students and Families;

As required by the Department of Public Health, we are providing you with information regarding meningococcal disease as well as information on the availability, effectiveness, and risks of the meningococcal vaccine. Please review the attached information. For more information please refer to the link below or call Massachusetts Department of Public Health, Division of Epidemiology and Immunization at 617-983-6800. Meningococcal Disease and Students: Commonly Asked Questions Mass.Gov Meningococcal Disease Information

Sincerely, The School Nurses

Penny McKay, MSN, RN John D. McGovern School 9 Lovering Street, Medway, MA 02053 tel 508-533-6626 ext 5354 fax 508-533-3263 [email protected]

Cheryl F. Gay, BSN, RN, NCSN Memorial Elementary School 16 Cassidy Lane, Medway, MA 02053 508-533-3265 x5152 fax 508-533-3274 [email protected]

Colleen Langille, BSN, RN, NCSN Medway Middle School 45 Holliston Street, Medway, MA 02053 508-533-7654 x4123 fax 508-321-4753 [email protected]

Christine Babicz, MSN, RN Nurse Coordinator Medway Public Schools School Nurse Medway High School 88 Summer Street, Medway MA 02053 508-533-6643 x 5008 fax 508-533-3246 [email protected]

Meningococcal Disease and Students: Commonly Asked Questions

What is meningococcal disease? Meningococcal disease is caused by infection with bacteria called Neisseria meningitidis. These bacteria can infect the tissue (the “meninges”) that surrounds the brain and spinal cord and cause meningitis, or they may infect the blood or other organs of the body. In the US, about 1,000-1,200 people get meningococcal disease each year and 10-15% die despite receiving antibiotic treatment. Of those who survive, about 11-19% may lose limbs, become hard of hearing or deaf, have problems with their nervous system, including long term neurologic problems, or have seizures or strokes.

How is meningococcal disease spread? These bacteria are passed from person-to-person through saliva (spit). You must be in close contact with an infected person’s saliva in order for the bacteria to spread. Close contact includes activities such as kissing, sharing water bottles, sharing eating/drinking utensils or sharing cigarettes with someone who is infected; or being within 3-6 feet of someone who is infected and is coughing or sneezing.

Who is most at risk for getting meningococcal disease? High-risk groups include anyone with a damaged spleen or whose spleen has been removed, those with persistent complement component deficiency (an inherited immune disorder), HIV infection, those traveling to countries where meningococcal disease is very common, microbiologists and people who may have been exposed to meningococcal disease during an outbreak. People who live in certain settings such as college freshmen living in dormitories and military recruits are also at greater risk of disease caused by some of the serotypes.

Are students at increased risk for meningococcal disease? The risk of meningococcal disease starts to increase in adolescence and young adulthood. In this age group, the highest rates of disease are in those 15-24 years of age.

Is there a vaccine against meningococcal disease? Yes, there are 3 different meningococcal vaccines. Quadrivalent meningococcal conjugate vaccine (Menactra and Menveo) protects against 4 serotypes (A, C, W and Y) of meningococcal disease. Meningococcal serogroup B vaccine (Bexsero and Trumenba) protects against serogroup B meningococcal disease, for age 10 and older. Quadrivalent meningococcal polysaccharide vaccine (Menomune) is recommended for people age 56 and older with certain high-risk conditions.

Should my child or adolescent receive meningococcal vaccine? Different meningococcal vaccines are recommended for a range of age and risk groups. Quadrivalent meningococcal conjugate vaccine is recommended routinely for children 11-12 years of age, with a second dose at age 16. MDPH strongly recommends two doses of quadrivalent meningococcal conjugate vaccine: a first dose at age 11-12 years, with a second dose at 16 years. College freshmen and other newly enrolled college students living in dormitories who are not yet vaccinated are also recommended to receive meningococcal conjugate vaccine.

Meningococcal B vaccine is recommended for people over age 10 in certain relatively rare high risk groups. In addition, adolescents and young adults (16 through 23 years of age) may be vaccinated with a serogroup B meningococcal vaccine, preferably at 16 through 18 years of age, to provide short term protection for most strains of serogroup B meningococcal disease. Talk with your doctor about which vaccines your child should receive.

Massachusetts law requires newly enrolled full-time students attending colleges and schools with grades 9-12, who will be living in a dormitory or other congregate housing, licensed or approved by the school or college, to receive a dose of quadrivalent meningococcal vaccine (A, C, W, Y) or sign a waiver declining vaccination. There is no requirement for meningococcal B vaccine for entry to school or college. More information about this requirement may be found in the MDPH document entitled “Information about Meningococcal Disease and Vaccination and Waiver for Students at Residential Schools and Colleges.”

How can I protect my child from getting meningococcal disease? The best protection against meningococcal disease and many other infectious diseases is thorough and frequent handwashing, respiratory hygiene and cough etiquette. Individuals should: 1. wash their hands often, especially after using the toilet and before eating or preparing food (hands should be washed with soap and water or an alcohol-based hand gel or rub may be used if hands are not visibly dirty); 2. cover their nose and mouth with a tissue when coughing or sneezing and discard the tissue in a trash can; or if they don’t have a tissue, cough or sneeze into their upper sleeve. 3. not share food, drinks or eating utensils with other people, especially if they are ill.

If your child is exposed to someone with meningococcal disease, antibiotics may be recommended to keep your child from getting sick. You can obtain more information about meningococcal disease or vaccination from your healthcare provider, your local board of health (listed in the phone book under government), or the MDPH Division of Epidemiology and Immunization at (617) 983-6800 or on the MDPH website at www.mass.gov/dph.

Massachusetts Department of Public Health Division of Epidemiology and Immunization, 305 South Street, Jamaica Plain, MA 02130 October 2016 Provided by the Massachusetts Department of Public Health in accordance with M.G.L. c.111, s.219.

45 Holliston Street Medway, MA 02053 Armand Pires, Ph.D. OFFICE: 508-533-3222 Superintendent of Schools FAX: 508-533-3226

August 2017

Dear Parent/Guardian: Children need healthy meals to learn. Medway Public Schools offers healthy meals every school day. Lunch costs $2.90 at the middle and high schools and $2.65 at the elementary schools. Your children may qualify for free meals or for reduced price meals. Reduced price is $.40 for lunch. This packet includes an application for free or reduced price meal benefits, and a set of detailed instructions. Below are some common questions and answers to help you with the application process. 1. WHO CAN GET FREE OR REDUCED PRICE MEALS?  All children in households receiving benefits from MA SNAP or MA TANF, are eligible for free meals.  Foster children that are under the legal responsibility of a foster care agency or court are eligible for free meals.  Children participating in their school’s Head Start program are eligible for free meals.  Children who meet the definition of homeless, runaway, or migrant are eligible for free meals.  Children may receive free or reduced price meals if your household’s income is within the limits on the Federal Income Eligibility Guidelines. Your children may qualify for free or reduced price meals if your household income falls at or below the limits on this chart.

FEDERAL ELIGIBILITY INCOME CHART For School Year ~ 2017-2018 Household size Yearly Monthly Weekly 1 22,311 1,860 430 2 30,044 2,504 578 3 37,777 3,149 727 4 45,510 3,793 876 5 53,243 4,437 1,024 6 60,976 5,082 1,173 7 68,709 5,726 1,322 8 76,442 6,371 1,471 Each additional person: 7,733 645 149

2. HOW DO I KNOW IF MY CHILDREN QUALIFY AS HOMELESS, MIGRANT, OR RUNAWAY? Do the members of your household lack a permanent address? Are you staying together in a shelter, hotel, or other temporary housing arrangement? Does your family relocate on a seasonal basis? Are any children living with you who have chosen to leave their prior family or household? If you believe children in your household meet these descriptions and haven’t been told your children will get free meals, please call or e-mail Kathleen Bernklow at 508-533-3229 or email [email protected]. 3. DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No. Use one Free and Reduced Price School Meals Application for all students in your household. We cannot approve an application that is not complete, so be sure to fill out all required information. Return the completed application to: Office of the Superintendent, 45 Holliston Street, Medway, MA 02053. 4. SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS SCHOOL YEAR SAYING MY CHILDREN ARE ALREADY APPROVED FOR FREE MEALS? No, but please read the letter you got carefully and follow the instructions. If any children in your household were missing from your eligibility notification, Office of the Superintendent, 45 Holliston Street, Medway, MA 02053 or call 508-533-3222 ext. 3157 immediately.

“Excellence for all through learning” Equal Opportunity Employer

45 Holliston Street Medway, MA 02053 Armand Pires, Ph.D. OFFICE: 508-533-3222 Superintendent of Schools FAX: 508-533-3226

5. MY CHILD’S APPLICATION WAS APPROVED LAST YEAR. DO I NEED TO FILL OUT A NEW ONE? Yes. Your child’s application is only good for that school year and for the first few days of this school year, through October 19, 2017. You must send in a new application unless the school told you that your child is eligible for the new school year. If you do not send in a new application that is approved by the school or you have not been notified that your child is eligible for free meals, your child will be charged the full price for meals.

6. I GET WIC. CAN MY CHILDREN GET FREE MEALS? Children in households participating in WIC may be eligible for free or reduced price meals. Please send in an application.

7. WILL THE INFORMATION I GIVE BE CHECKED? Yes. We may also ask you to send written proof of the household income you report.

8. IF I DON’T QUALIFY NOW, MAY I APPLY LATER? Yes, you may apply at any time during the school year. For example, children with a parent or guardian who becomes unemployed may become eligible for free and reduced price meals if the household income drops below the income limit.

9. WHAT IF I DISAGREE WITH THE SCHOOL’S DECISION ABOUT MY APPLICATION? You should talk to school officials. You also may ask for a hearing by calling or writing to: Office of the Superintendent, 45 Holliston Street, Medway, MA 02053 or 508-533-3222 ext. 3157.

10. MAY I APPLY IF SOMEONE IN MY HOUSEHOLD IS NOT A U.S. CITIZEN? Yes. You, your children, or other household members do not have to be U.S. citizens to apply for free or reduced price meals.

11. WHAT IF MY INCOME IS NOT ALWAYS THE SAME? List the amount that you normally receive. For example, if you normally make $1000 each month, but you missed some work last month and only made $900, put down that you made $1000 per month. If you normally get overtime, include it, but do not include it if you only work overtime sometimes. If you have lost a job or had your hours or wages reduced, use your current income.

12. WHAT IF SOME HOUSEHOLD MEMBERS HAVE NO INCOME TO REPORT? Household members may not receive some types of income we ask you to report on the application, or may not receive income at all. Whenever this happens, please write a 0 in the field. However, if any income fields are left empty or blank, those will also be counted as zeroes. Please be careful when leaving income fields blank, as we will assume you meant to do so.

13. WE ARE IN THE MILITARY. DO WE REPORT OUR INCOME DIFFERENTLY? Your basic pay and cash bonuses must be reported as income. If you get any cash value allowances for off-base housing, food, or clothing, it must also be included as income. However, if your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income. Any additional combat pay resulting from deployment is also excluded from income.

14. WHAT IF THERE ISN’T ENOUGH SPACE ON THE APPLICATION FOR MY FAMILY? List any additional household members on a separate piece of paper, and attach it to your application. Contact Office of the Superintendent, 45 Holliston Street, Medway, MA 02053 or 508-533-3222 ext. 3157 to receive a second application.

15. MY FAMILY NEEDS MORE HELP. ARE THERE OTHER PROGRAMS WE MIGHT APPLY FOR? To find out how to apply for MA SNAP or other assistance benefits, contact your local assistance office or call MA hotline 866-950-3663.

If you have other questions or need help, call 508-533-3222 ext. 3157.

Sincerely,

Armand Pires, Ph.D. Superintendent

“Excellence for all through learning” Equal Opportunity Employer

45 Holliston Street Medway, MA 02053 Armand Pires, Ph.D. OFFICE: 508-533-3222 Superintendent of Schools FAX: 508-533-3226

HOW TO APPLY FOR FREE AND REDUCED PRICE SCHOOL MEALS Please use these instructions to help you fill out the application for free or reduced price school meals. You only need to submit one application per household, even if your children attend more than one school in Medway. The application must be filled out completely to certify your children for free or reduced price school meals. Please follow these instructions in order! Each step of the instructions is the same as the steps on your application. If at any time you are not sure what to do next, please contact Office of the Superintendent, 508-533-3222 ext. 3157. PLEASE USE A PEN (NOT A PENCIL) WHEN FILLING OUT THE APPLICATION AND DO YOUR BEST TO PRINT CLEARLY.

STEP 1: LIST ALL HOUSEHOLD MEMBERS WHO ARE INFANTS, CHILDREN, AND STUDENTS UP TO AND INCLUDING GRADE 12 Tell us how many infants, children, and school students live in your household. They do NOT have to be related to you to be a part of your household. Who should I list here? When filling out this section, please include ALL members in your household who are:  Children age 18 or under AND are supported with the household’s income;  In your care under a foster arrangement, or qualify as homeless, migrant, or runaway youth;  Students attending Medway Public Schools, regardless of age. A) List each child’s name. Print each B) Is the child a student at C) Do you have any foster children? If D) Are any children child’s name. Use one line of the Medway Public Schools? any children listed are foster children, homeless, migrant, or application for each child. When Mark ‘Yes’ or ‘No’ under the mark the “Foster Child” box next to the runaway? If you believe printing names, write one letter in column titled “Student” to child’s name. If you are ONLY applying any child listed in this each box. Stop if you run out of tell us which children for foster children, after finishing STEP 1, section meets this space. If there are more children attend Medway Public go to STEP 4. description, mark the present than lines on the Schools. If you marked Foster children who live with you may “Homeless, Migrant, application, attach a second piece of ‘Yes,’ write the grade level count as members of your household and Runaway” box next to the paper with all required information of the student in the should be listed on your application. If child’s name and complete for the additional children. ‘Grade’ column to the right. you are applying for both foster and non- all steps of the application. foster children, go to step 3. STEP 2: DO ANY HOUSEHOLD MEMBERS CURRENTLY PARTICIPATE IN SNAP, TANF, OR FDPIR? If anyone in your household (including you) currently participates in one or more of the assistance programs listed below, your children are eligible for free school meals:  The Supplemental Nutrition Assistance Program MA SNAP.  Temporary Assistance for Needy Families MA TANF.

A) If no one in your household B) If anyone in your household participates in any of the above listed programs: participates in any of the above listed  Write a case number for SNAP or TANF. You only need to provide one case number. If you programs: participate in one of these programs and do not know your case number, contact: MA SNAP.  Leave STEP 2 blank and go to STEP 3.  Go to STEP 4.

45 Holliston Street Medway, MA 02053 Armand Pires, Ph.D. OFFICE: 508-533-3222 Superintendent of Schools FAX: 508-533-3226

STEP 3: REPORT INCOME FOR ALL HOUSEHOLD MEMBERS How do I report my income?  Use the charts titled “Sources of Income for Adults” and “Sources of Income for Children,” printed on the back side of the application form to determine if your household has income to report.  Report all amounts in GROSS INCOME ONLY. Report all income in whole dollars. Do not include cents. o Gross income is the total income received before taxes. o Many people think of income as the amount they “take home” and not the total, “gross” amount. Make sure that the income you report on this application has NOT been reduced to pay for taxes, insurance premiums, or any other amounts taken from your pay.  Write a “0” in any fields where there is no income to report. Any income fields left empty or blank will also be counted as a zero. If you write ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report. If local officials suspect that your household income was reported incorrectly, your application will be investigated.

 Mark how often each type of income is received using the check boxes to the right of each field.

3.A. REPORT INCOME EARNED BY CHILDREN A) Report all income earned or received by children. Report the combined gross income for ALL children listed in STEP 1 in your household in the box marked “Child Income.” Only count foster children’s income if you are applying for them together with the rest of your household. What is Child Income? Child income is money received from outside your household that is paid DIRECTLY to your children. Many households do not have any child income. 3.B REPORT INCOME EARNED BY ADULTS Who should I list here?  When filling out this section, please include ALL adult members in your household who are living with you and share income and expenses, even if they are not related and even if they do not receive income of their own.  Do NOT include: o People who live with you but are not supported by your household’s income AND do not contribute income to your household. o Infants, Children and students already listed in STEP 1. B) List adult household C) Report earnings from work. Report all income D) Report income from public assistance/child members’ names. Print the from work in the “Earnings from Work” field on the support/alimony. Report all income that applies in name of each household application. This is usually the money received from the “Public Assistance/Child Support/Alimony” member in the boxes marked working at jobs. If you are a self-employed business field on the application. Do not report the cash “Names of Adult Household or farm owner, you will report your net income. value of any public assistance benefits NOT listed Members (First and Last).” Do on the chart. If income is received from child not list any household members What if I am self-employed? Report income from support or alimony, only report court-ordered you listed in STEP 1. If a child that work as a net amount. This is calculated by payments. Informal but regular payments should listed in STEP 1 has income, subtracting the total operating expenses of your be reported as “other” income in the next part. follow the instructions in STEP business from its gross receipts or revenue. 3, part A. E) Report income from F) Report total household size. Enter the total G) Provide the last four digits of your Social pensions/retirement/all other number of household members in the field “Total Security Number. An adult household member income. Report all income that Household Members (Children and Adults).” This must enter the last four digits of their Social applies in the number MUST be equal to the number of household Security Number in the space provided. You are “Pensions/Retirement/ All members listed in STEP 1 and STEP 3. If there are any eligible to apply for benefits even if you do not Other Income” field on the members of your household that you have not listed have a Social Security Number. If no adult application. on the application, go back and add them. It is very household members have a Social Security important to list all household members, as the size Number, leave this space blank and mark the box of your household affects your eligibility for free and to the right labeled “Check if no SSN.” reduced price meals.

45 Holliston Street Medway, MA 02053 Armand Pires, Ph.D. OFFICE: 508-533-3222 Superintendent of Schools FAX: 508-533-3226

STEP 4: CONTACT INFORMATION AND ADULT SIGNATURE All applications must be signed by an adult member of the household. By signing the application, that household member is promising that all information has been truthfully and completely reported. Before completing this section, please also make sure you have read the privacy and civil rights statements on the back of the application. A) Provide your contact information. B) Print and sign C) Mail D) Share children’s racial and ethnic identities Write your current address in the fields your name and write Completed Form (optional). On the back of the application, we ask provided if this information is available. today’s date. Print to: Office of the you to share information about your children’s race If you have no permanent address, this the name of the Superintendent, and ethnicity. This field is optional and does not does not make your children ineligible adult signing the 45 Holliston affect your children’s eligibility for free or reduced for free or reduced price school meals. application and that Street, Medway, price school meals. Sharing a phone number, email address, person signs in the MA 02053 or both is optional, but helps us reach box “Signature of you quickly if we need to contact you. adult.”

2017-2018 Prototype Household Application for Free and Reduced Price School Meals Apply online: Complete one application per household. Please use a pen (not a pencil).

STEP 1 List ALL Household Members who are infants, children, and students up to and including grade 12 (if more spaces are required for additional names, attach another sheet of paper)

Homeless, Student? Foster Migrant, Definition of Household Child’s First Name MI Child’s Last Name Grade Yes No Child Runaway Member: “Anyone who is living with you and shares income and expenses, even if not related.”

Children in Foster care and children who meet the definition of Homeless, Migrant or Runaway are

eligible for free meals. Read apply that all Check How to Apply for Free and Reduced Price School Meals for more information.

STEP 2 Do any Household Members (including you) currently participate in one or more of the following assistance programs: SNAP, TANF, or FDPIR?

NO > Go to STEP 3 If YES > Write a case number here then go to STEP 4 (Do not complete STEP 3) Case Number: Write only one case number in this space.

STEP 3 Report Income for ALL Household Members (Skip this step if you answered ‘Yes’ to STEP 2)

How often? A. Child Income Child income Weekly Bi-Weekly 2x Month Monthly Sometimes children in the household earn or receive income. Please include the TOTAL income received by all Household Members listed in STEP 1 here. $ B. All Adult Household Members (including yourself) Are you unsure what List all Household Members not listed in STEP 1 (including yourself) even if they do not receive income. For each Household Member listed, if they do receive income, report total gross income (before taxes) income to include here? for each source in whole dollars (no cents) only. If they do not receive income from any source, write ‘0’. If you enter ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report. How often? How often? How often? Flip the page and review Public Assistance/ Pensions/Retirement/ the charts titled “Sources Name of Adult Household Members (First and Last) Earnings from Work Weekly Bi-Weekly 2x Month Monthly Child Support/Alimony Weekly Bi-Weekly 2x Month Monthly All Other Income Weekly Bi-Weekly 2x Month Monthly of Income” for more information. $ $ $ The “Sources of Income for Children” chart will $ $ $ help you with the Child Income section. $ $ $ The “Sources of Income for Adults” chart will help $ $ $ you with the All Adult Household Members section. $ $ $

Total Household Members Last Four Digits of Social Security Number (SSN) of XX Check if no SSN (Children and Adults) Primary Wage Earner or Other Adult Household Member XXX

STEP 4 Contact information and adult signature. MAIL COMPLETED FORM TO YOUR SCHOOL AT:

“I certify (promise) that all information on this application is true and that all income is reported. I understand that this information is given in connection with the receipt of Federal funds, and that school officials may verify (check) the information. I am aware that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted under applicable State and Federal laws.”

Street Address (if available) Apt # City State Zip Daytime Phone and Email (optional)

Printed name of adult signing the form Signature of adult Today’s date INSTRUCTIONS Sources of Income

Sources of Income for Children Sources of Income for Adults Sources of Child Income Public Assistance / Pensions / Retirement / Example(s) Earnings from Work Alimony / Child Support All Other Income - A child has a regular full or part-time job - Earnings from work - Salary, wages, cash - Unemployment benefits - Social Security where they earn a salary or wages bonuses - Worker’s compensation (including railroad - Net income from self- - Supplemental Security retirement and black lung - Social Security - A child is blind or disabled and receives Social employment (farm or Income (SSI) benefits) - Disability Payments Security benefits business) - Cash assistance from - Private pensions or - Survivor’s Benefits - A parent is disabled, retired, or deceased, and disability benefits If you are in the U.S. Military: State or local their child receives Social Security benefits government - Regular income from -Income from person outside the household - A friend or extended family member - Basic pay and cash bonuses - Alimony payments trusts or estates regularly gives a child spending money (doNOT include combat pay, - Child support payments - Annuities - Investment income FSSA or privatized housing - Veteran’s benefits - Strike benefits - Earned interest -Income from any other source - A child receives regular income from a allowances) - Rental income private pension fund, annuity, or trust - Allowances for off-base housing, - Regular cash payments food and clothing from outside household

OPTIONAL Children's Racial and Ethnic Identities

We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for free or reduced price meals.

Ethnicity (check one): Hispanic or Latino Not Hispanic or Latino Race (check one or more): American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

The Richard B. Russell National School Lunch Act requires the information on this application. You do Persons with disabilities who require alternative means of communication for program information (e.g. Braille, not have to give the information, but if you do not, we cannot approve your child for free or reduced price large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they meals. You must include the last four digits of the social security number of the adult household member who applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA signs the application. The last four digits of the social security number is not required when you apply on through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary available in languages other than English. Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult household Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA member signing the application does not have a social security number. We will use your information to office, or write a letter addressed to USDA and provide in the letter all of the information requested in the determine if your child is eligible for free or reduced price meals, and for administration and enforcement of form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to the lunch and breakfast programs. We MAY share your eligibility information with education, health, and USDA by: nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for mail: U.S. Department of Agriculture program reviews, and law enforcement officials to help them look into violations of program rules. *Only use this address if you Office of the Assistant Secretary for Civil Rights are filing a complaint of In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations 1400 Independence Avenue, SW discrimination and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or Washington, D.C. 20250-9410 administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, fax: (202) 690-7442; or disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or email: [email protected]. funded by USDA. This institution is an equal opportunity provider.

Do not fill out For School Use Only

Annual Income Conversion: Weekly x 52, Every 2 Weeks x 26, Twice a Month x 24 Monthly x 12 How often? Eligibility: Total Income Weekly Bi-Weekly 2x Month Monthly Household Size Free Reduced Denied Categorical Eligibility

Determining Official’s Signature Date Confirming Official’s Signature Date Verifying Official’s Signature Date

Medway Public Schools Student Vaccine Exemption 2018

As a parent / guardian, having responsibility for

______, a minor enrolled in Medway Public Schools, I request that said minor be exempt from the vaccination and immunization requirements on medical and/or religious grounds in accordance with the provisions of chapter 76, Section 15, General Laws of Massachusetts. https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXII/Chapter76/Section15

I request that my child be exempt from the following vaccination and immunization requirements (please list)______​ ​ ______

This decision is based on: Please check off all that apply ​

❏ Religious Grounds, Receipt of vaccination and immunization would ​ conflict with my sincere religious beliefs. ❏ Medical Grounds - Explain:______​ ______

❏ I have attached a letter from a medical provider indicating the need for a medical exemption from vaccination and immuniation, yearly rquirements of M.G.L. Ch. 76, Sec. 15.

I realize that according to the Massachusetts Department of Public Health, my child may be excluded from school and school functions should an outbreak of a communicable disease occur. ______parent/guardian initials ​

Parent/Guardian:______Date:______

Address:______

Principal:______Date:______

School Nurse:______Date:______Post to: Blackboard, Daily News, Website

During the 2018-2019 school year, the Medway Public Schools will offer three sections of integrated preschool programming. As well, we are excited to share that there will also be a limited number of full day preschool slots for which students will be selected through a lottery process.

Integrated preschool is overseen by the Department of Early Education and Care (EEC). This is ​ mandated to ensure that eligible 3, 4, and 5 year-old children with disabilities are appropriately identified as eligible for special education and receive developmentally appropriate special education and related services designed to meet their individual needs. This is in accordance with the Individuals with Disabilities Education Act - 2004 (IDEA-2004) and Massachusetts Special Education laws and regulations. Part of the service for these students includes the integration of non-disabled peers who are available as peer models.

If you wish to be considered for this program (either the full day or ½ day sessions), integrated lottery forms will be available for parents beginning February 2, 2018, either online or to pick up at the Office of Student Services, 45 Holliston Street (door #4). These forms are to be completed and returned to the ​ ​ ​ Student Services Office School by Thursday February 22nd at 2:00 p.m. We will be conducting a public ​ lottery on Friday February 23, 2018, at the McGovern School at 9:30 a.m.

If your child’s name is chosen through the lottery process, we will contact you. Please note that we cannot guarantee any particular session for your child. Once the lottery system is completed we will maintain a waiting list with the remaining names. Final hours and and tuition rate(s) will be subject to school committee approval and will be communicated as soon as possible.

Once the lottery process is completed and students are identified, the, integrated preschool registration will be held in the Library of the McGovern Elementary School, 9 Lovering Street, on Tuesday, February ​ ​ ​ 27, 2018, from 3:30 p.m. to 6:00 p.m., and Saturday, March 3, 2018 from 9:00 a.m. to 12:00 p.m.

February 1, 2018 Medway Integrated Preschool ​ Typically Developing Peer (TDP) Application

Dear Parent/Guardian,

During the 2018-2019 school year, we will be offering a five day a week preschool program. This year we will be offering a limited number of full day seats in addition to our half day slots. Full and half day openings are determined via a lottery, and typically developing peers must be 4 years of age by August 31, 2018 in order to be entered into the full day lottery. Tuition for this program is $3,275 for half day and $6,550 for full day. Morning session is 8:55 a.m. - 11:15 a.m., afternoon session is 12:10 p.m. - 2:30 p.m. and full day is 8:55 a.m. - 2:30 p.m.

Starting in October 2018, Medway Integrated Preschool will be conducting arena assessments on the first and third Wednesday of the month. On the first Wednesday there we will be no morning preschool and on the third Wednesday of the month there will be no afternoon preschool.

If you wish to be considered for this program, please fill out the form below and return it to the Office of Student Services, 45 Holliston St., door number 4, by February 22, 2018 no later than 2:00 p.m. We will be conducting a public lottery at the McGovern School on February 23, 2018.

Once the lottery is completed, we will keep a sequential waiting list with the remaining names of students in the event that a slot becomes open during the school year.

Please do not hesitate to contact either of us if you have any questions.

Respectfully,

Vicky Fanelli Linda Weene

Vicky Fanelli, Evaluation Team Supervisor Linda Weene, McGovern Interim Principal

Please return this page on or before February 23, 2018

______I would prefer my child to attend full day 4-5 year program.

______I would prefer my 4-5 year old child to attend the full day and if not available consideration for half day preschool.

______I would prefer my child to attend the half day program only for ages 3-5.

______Child’s Name (Please Print) Child’s Date of Birth

______Parent/Guardian Signature

Parent/Guardian Name (Please print)

______

Address: ______

______

______

Home Phone # ______

Cell Phone # ______

Email: ______

“Excellence for all through learning” Equal Opportunity Employer