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Important Forms for Students & Staff

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 Enrollment Agreement

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

CACFP Participant Enrollment Form

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

Sunscreen Permission Form

Employee Forms

Application for Employment

Emergency Information - Staff

Health Questionnaire - Staff

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

Direct Deposit Authorization Form

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

Therapist/Visitor Forms

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

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

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)

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

*The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)