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Important Forms

New Student Enrollment Forms

All new students will need the following forms completed prior to beginning school.  If you have questions please feel free to email the Executive Director, Nicole Butters at nbutters@whiteplainschildrenscenter.org.

WPCC Student Application

WPCC Student Application

WPCC Enrollment Agreement

This will be sent to you via Adobe Sign once enrollment date is set.

CACFP Participant Enrollment Form

CACFP Participant Enrollment Form

Illness & COVID-19 Policies

COVID-19 Policies & Procedures

Children's Medical Form

THIS FORM MUST BE PRINTED. The top-half needs to be completed by a parent/guardian. The bottom-half must be completed & signed by the child's doctor.

Children's Medical Form

Children's Immunization Record

Please email or fax us a copy of your child's up-to-date immunization record

Sunscreen Permission Form

WPCC provides Rocky Mountian Broad Spectrum KIDS Sunscreen SPF 30 and we apply in the afternoon before going outside. If you prefer for your child to use a different sunscreen please reach out to administration.

Sunscreen Permission Form

Infant Feeding Form

This form is only necessary for children aged 15 months or younger.

Infant Feeding Form

Annual Student Forms

These forms are needed annually in July for all currently enrolled students.

Annual Emergency Info. Update

CACFP Participant Enrollment Form

COVID-19 Policies & Procedures

WPCC provides Rocky Mountian Broad Spectrum KIDS Sunscreen SPF 30 and we apply in the afternoon before going outside. If you prefer for your child to use a different sunscreen please reach out to administration.

Sunscreen Permission Form

Therapist/Visitor Forms

Confidentiality Form

Emergency Information - Therapist/Volunteer

A health professional MUST conduct TB screening. Please do not pre-answer the questions before seeing a medical professional. Any negative TB test results within the last year are sufficient.

TB Screening/Test Results

We require all therapists who are serving a student onsite to provide the center with a copy of their liability insurance.

Proof of Liability Insurance

Miscellaneous Forms

Please use this form for diaper cream, lotions, etc.

Over-The-Counter Topical Cream Permission Form

Please use this form to give WPCC permission to serve your child something other than milk at lunch/breakfast.

Meal Time Drink Preference Permission

Please use this form to request modified meals due to food allergy, food intolerance or family preference.

CCSA Special Diet Request Form

This form is only applicable to students enrolled at WPCC as a Wake County student. If your child is not a Wake County student please use the Release of Information form below.

Authorization for Exchange of Confidential Information (WCPSS Students)

Please use this form to consent for a release/exchange of information pertaining to your child. If your child is a Wake County student please use the form listed above.

Authorization for Exchange of Confidential Information (Non-WCPSS Students)

Personal Sunscreen Permission Form

Suncreen provided from home must not be expired, must be commercially packaged (ie: not homemade), must have an ingredients list on the package, and must have the child's full name written on it.

Personal Sunscreen Permission Form

Special Health Care Forms

This form is for any student that requires the use of an inhaler and/or nebulizer for asthma. This form will need to be printed and completed by your child's doctor.

Medical Action Plan - Asthma

This form is for any student that has diabetes. This form will need to be printed and completed by your child's doctor.

Medical Action Plan - Diabetes

This form is for any student that has a food allergy that requires the use of emergency medication. This form will need to be printed and completed by your child's doctor.

Medical Action Plan - Food Allergy

This form is for any student that has a history of a seizure disorder. This form will need to be printed and completed by your child's doctor.

Medical Action Plan - Seizure