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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.

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

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

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

Infant Feeding Form

This section includes reference links that are important for families to read and understand, but are not specifically a form and do not require a signature.

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

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

A health professional MUST conduct the TB screening. Please do not pre-answer the questions before seeing a medical professional.

TB Screening/Test Results

A health professional MUST complete the Health Assessment/Medical Report

Staff Health Assessment/Medical Report

You will need an NCID number before completing the background check process. Please click the link below. Once there, click the ``You Will Need`` button in the bottom left corner. This will guide you through the background check and fingerprinting process.

Background Check Portal

This form is required for all outside therapists to reserve time to see clients at WPCC due to COVID-19 restrictions.

Outside Therapist Sign-Up Form

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

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)

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