2024-25 WMCC AYC Program Registration

WMCC Afterschool Youth Club Registration

The West Medford Community Center is now accepting registrations for the 2024-25 school year. The after school youth club accepts kids in grades 4-8 yrs old. Registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list. The cost is $50 per family for registration fee then your chosen program fee per month per child. Both new and returning families are responsible for a yearly non-refundable registration fee of $50 per family. If the student withdraws from the program prior to the start of the new school year or at any time during the school year, the registration fee is non-refundable. AYC Program Fee Schedule: $500.00 per month for 5 days a week; $300.00 per month for 3 days a week; $200.00 per month for 2 days a week. Full payment is due prior to the first of every month (ex October AYC fee due by September 30th). WMCC will invoice you for payment each month. Payment may be made by cash, check, credit card, Apple Pay or CashApp. Program scholarships are available on a need basis for both registration fee and program fees. Please reach out to info@wmcc.us for more information.
After School Care Registration Form

The Afterschool Youth Club is available 2pm-6pm Monday-Friday & beginning at 12pm on Medford Public Schools half days. **Medford Junior High School and the Brooks Elementary School drop kids off at the intersection of Arlington Street and Harvard Avenue where a staff will meet the bus (three houses down from our facility). Please verify transportation options with your child’s school to ensure proper transportation to the center. The average adult to child ratio is 1:12. Staff credentials vary with a mix of college degrees, experience with school-age children and activity specialization. Additional activities will be provided to all of the youth on a daily basis. Programming will reflect both activities that are planned by the adult staff and those ideas the kids generate themselves and will include (but not be limited to) sports and physical activities, STEM, arts and crafts and computer games.
Student Information

If you have more than one child that you will be sending to the AYC Program please enter below under Student 2, please be sure to complete all the information.
Student 1 Name*

First NameMiddle NameLast Name
Grade Attending in September 2024*
School Attending*
If you selected "other" for school name, please enter school name and city here.
Birth Date*

MonthDayYear
AGE*
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does you child have a current IEP or 504 Plan?*
*If you answered yes, please upload documents in the next question. Documents may be provided in person or by email to lcrossman@wmcc.us.
Upload IEP and/or 504 plan

Cancelof
Health Care Number*
Doctor's Name*
Doctor's Phone Number*
Student 2 Name

First NameMiddle NameLast Name
Grade Attending in September 2024*
Birth Date

MonthDayYear
AGE
Gender
Address (if different from Student 1)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does you child have a current IEP or 504 Plan?*
*If you answered yes, please upload documents in the next question. Documents may be provided in person or by email to lcrossman@wmcc.us.
Upload IEP and/or 504 plan

Cancelof
Health Care Number
Doctor's Name
Doctor's Phone Number
Parent/Guardian Information (1)
Parent Guardian (1) Name*

First NameMiddle NameLast Name
Cell Phone Number*
Work Phone Number
Home Phone Number
Parent/Guardian (1) E-mail*
example@example.com
Address same as child?*

YesNo
Address if different than the child. If your address is different than the child's please fill out the info below. Otherwise move onto the next section.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information (2)
Parent Guardian (2) Name

First NameMiddle NameLast Name
Cell Phone Number
Work Phone Number
Home Phone Number
Parent/Guardian (2) E-mail
example@example.com
Address same as child?

YesNo
Address if different than the child. If your address is different than the child's please fill out the info below. Otherwise move onto the next section.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Other Information
Is your child immunized?*

YesNo
Does the child have any allergies? If yes, list any food or drug allergies below.*
Does the child have any medical conditions? If yes list any medical conditions below.*
Pick Up

Please list the names of the people approved to pick up your child from afterschool youth club. People on the authorized list will need to provide a photo id in order for AYC staff to release your child to them.
Approved Pick Up Person #1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Approved Pick Up Person #2

First NameLast Name
Phone Number
Please enter a valid phone number.
Approved Pick Up Person #3

First NameLast Name
Phone Number
Please enter a valid phone number.
Emergency Contact - Other than Parent/Guardian
Emergency Contact Name*

First NameMiddle NameLast Name
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Work Phone Number
Home Phone Number

Permissions, Releases, Emergency Arrangements

This section MUST be completed by the youth member’s parent/guardian. Please review and initial your acceptance of all club arrangements. If you have special requests or concerns, please provide us with additional information.
Agreement to abide by club rules:

I understand that my child must abide by club rules intended to ensure the safety and well-being of all youth members, staff, and volunteers. I understand that if my child is unable to do so, s/he may be required to leave the Club.
Signature*

Clear
Permission to participate in activities:

I give my child permission to participate in all the activities being offered by the West Medford Community Center Youth Club and certify that my child is physically healthy to participate in all activities. I will inform the Center and document any reasonable accommodations my child may need in order to participate in these activities. (All activities will take place at the West Medford Community Center or Dugger Park.)
YESNO
Parent/Guardian Signature*

Clear
Other Permissions. Please indicate those you AGREE to by checking the box. Check all that apply.*

Walks, sports, and other activities off site from WMCCPhotos of my child for use within the programPhotos of my child for use outside of the program 9i.e social media, newsletter, website, etc.
Signature*

Clear
Permission to Depart. Please indicate those permissions you AGREE to by checking the box. Check all that apply.

Leave the club alone to walk homeLeave the club with a friend to walk homeOnly leave the club with parent/guardian or pre-approved adult on the pick-up list
Signature

Clear
Waivers:

I understand that the West Medford Community Center does not carry "Student Accident Insurance." I agree to save and hold harmless the West medford Community Center, its staff, volunteers, and Board of Directors from any and all liability for any damages or injuries that may occur during my child's participation in AYC programs and activities.
Signature*

Clear

WMCC Afterschool Youth Club Registration Complete

All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list. The cost is $50 per family for AYC registration fee then the program fee based on your selection (5 days per week $500; 3 days per week $300; 2 days per week $200) per child. Also, note that currently masks are optional. WMCC has purchased HEPA air filters for each room in the center as a preventative measure. This mask policy may change throughout the year. We will keep you informed and follow all state & local guidance. Thank you for your participation in the after-school program.
Attendance Plan: Please indicate the number of days you expect your child to attend the club.*

5 Days a week (Program Fee $500)3 Days a week (Program Fee $3002 Days a week (Program Fee $200)
WMCC will invoice Parent/Guardian 1 in this form for monthly payment to the West Medford Community Center. If you are paying by check, endorse it to West Medford Community Center, 111 Arlington St., Medford, MA 02155. Please note “AYC” & month to be applies to on the memo line that indicates the reason for payment. Full payment is due prior to the first of every month (ex October AYC fee due by September 30th). If you incurred any late fees, they will appear on AYC invoices. Otherwise, the non-refundable program fee is all you will be charged near month start. Upon submission of the form, an AYC representative will reach out either by email or phone. Once you are confirmed with a WMCC staff and you accept the after school slot, your first invoice will appear in August. Please contact us at 781-483-3042 or info@wmcc.us for any questions or concerns.
Payment Information

My Products*

AYC Registration FeeBoth new and returning families are responsible for a yearly non-refundable registration fee of $50 per family. If the student withdraws from the program prior to the start of the new school year or at any time during the school year, the registration fee is non-refundable.

$50.00 Quantity

Enter coupon

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Should be Empty:

WMCC Afterschool Youth Club Registration

After School Care Registration Form

Student Information

Parent/Guardian Information (1)

Parent/Guardian Information (2)

Other Information

Pick Up

Emergency Contact - Other than Parent/Guardian

Permissions, Releases, Emergency Arrangements

WMCC Afterschool Youth Club Registration Complete

Payment Information

Payment Methods