KSTAY Application Form

KSTAY Application Form

For the ’26-’27 school year, WCCC’s KSTAY program will run on the following days: September 3rd, 4th, 8th, 10th and 11th. KStay does not run on Wednesdays, as WPS has early release days for all elementary school children. Therefore, our regular After School Program will run instead.
School Year of Application*
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 1 Relationship*
Parent/Guardian 1 Email*

Confirmation Emailexample@example.com
Parent/Guardian 1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Would you like to add a second parent/guardian?*

YesNo
Parent/Guardian 2 Name*

First NameLast Name
Parent/Guardian 2 Relationship*
Parent/Guardian 2 Email*

Confirmation Emailexample@example.com
Parent/Guardian 2 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Child's Name*

First NameLast Name
Child's Nickname
Date of Birth*

MonthDayYear
Date
School*
School attending beginning Fall of the application year.
Pricing
Will your child also be enrolled in our After School Program?*

Yes - $75 per blockNo - $90 per block
Requested Schedule
Week 1 - Thursday(9/3)*

YesNo
Week 1 - Friday(9/4)*

YesNo
Week 2 - Tuesday(9/8)*

YesNo
Week 2 - Thursday(9/10)*

YesNo
Week 2 - Friday(9/11)*

YesNo
Total Days: {dayCount}
Total Due: {totalDue}
Total Days
Total Due
Tell us more about your child
How would you describe your child?
Is there anything that you think would help us better understand your child (for example: divorce, death in the family, addition of a new family member)?
Language Spoke at Home
Does your child have allergies or a special diet?

YesNo
Allergies

DairyEggsTree NutsPeanutsShellfishWheatSoyFishSesameOther
Special Diet
Individual Health Plan due to a chronic health condition (ex. asthma, anaphylaxis)?

YesNo
Health Concerns
Individual Health Care Plan(IHCP)

Cancelof
Are there any custody agreements, court orders, or restraining orders pertaining to this child?

YesNo
Custody agreements, court orders or restraining orders Upload*

Cancelof
Does your child have any special limitations or concerns?

YesNo
Special limitations or concerns:
Does your child receive services during or outside of school (for example: PT, OT, speech)?

YesNo
Photo Permission(We often take photos of children participating in our programs. Check below if you do not want your child photographed.)

YesNo
Dismissal Plan*

Parent/Guardian PickupCar LineWPS BusMETCO BusWalker LineStaying with WCCC
Dismissal Plan Notes:
Payment
KSTAY Application Payment*

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USDKSTAY Application
STATEMENT OF NON-DISCRIMINATION

WCCC does not discriminate against any person in providing services to children and their families, or in its employment practices, on the basis of his or her race, gender, age, religion, sexual orientation, national origin, cultural heritage, political beliefs, retaliation, or marital status, except that as to the age of children, the provisions of any license issued to the corporation by any municipality of the Commonwealth shall govern the policy of the corporation. Our employment practices are consistent with the Americans with Disabilities Act.
Should be Empty:

KSTAY Application Form

Pricing

Requested Schedule

Total Due: {totalDue}

Tell us more about your child

Payment