Programs are Enrollment Dependent

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HOW TO REGISTER for school year programs
Register online at www.wisconsinyouthcompany.org
Please complete all forms entirely for each child or registration may be delayed
as we will need to contact you to collect this required information.
Parent Registration Checklist
Parts IA, IB, III and IV are 2-part forms (white & yellow), please
return white copy of the form to the administrative office. Keep
yellow copy for your records.
Parts IA & IB - Registration & Program Selection Forms
Complete both parts entirely. Part IA: write your child’s and your information, including your best address and phone
during program hours. List emergency contacts and persons
other than parents who are authorized to pick up your child,
and check the desired arrival/departure authorization for your
child. Part IB: select the days you would like your child to
attend program and sign payment agreement.
Part II - Health History & Emergency Care Plan Form
In compliance with state licensing requirements, children’s
health history and emergency care plans must be
reviewed and updated by parents or guardians.
Part III – Payment of Fees & Account Security Policies Form
This form must be completed in order to protect the privacy of
your account. Your account access password will be required
for all account inquiries and requests to change account
information.
Part IV – School Year 2014-2015 Registration Agreement Form
Be sure to read thoroughly before signing.
School Year 2014-2015 Credit/Debit Card Authorization (Optional)
Choose one-time or auto payment option.
Enrollment and Fees
Applications, online and paper forms, will be processed in the order
they are received. Three, four and five-day enrollments have priority
throughout the school year. In order to protect your enrollment,
families who initially register for less than three days a week have the
option of increasing their enrollment or they may withdraw from the
program if enrollment reaches capacity.
Programs are Enrollment Dependent
In order to provide a quality experience for your child, we need to
have sufficient enrollment to operate a program and offer specific age
groups within each program. If we are unable to offer the specific age
group or program you registered for, we will contact you to discuss
possible alternatives.
Confirmation Process
Families registering online and providing an email address will
receive an emailed confirmation of their child’s registration along
with a welcome packet including a parent handbook and bi-weekly
invoices. You may request a printed welcome packet by contacting the
administrative office.
Families who register using paper forms who don’t provide an email
address, will be mailed confirmation of their child’s registration along
with a welcome packet, a parent handbook and bi-weekly invoices.
Enrollment Cancellation/Change Policy
A written advance notice from the account holder (please include
password) must be received by the WYC administrative office to cancel
or change the enrollment. This written notice must be received by the
end of the business day Friday (5:30 p.m.) six business days prior to the
payment period. If we don’t receive your written cancellation in time
you will be liable for the remainder of the payment period. We do not
prorate during a billing cycle. Please do not give notices to program
staff.
Financial Assistance
Child care funding is available from the city or county for AFTER SCHOOL
programs for eligible families. Parents are responsible for initiating
and managing their funding source transactions. Once authorization
is received from a funding source, our accounts receivable department
will work with the parent to manage their account. It is the parent’s
responsibility to follow program billing and funding activity and make
timely payments for any remaining balances.
Limited scholarship funds through Wisconsin Youth Company may
be available on a first-come, first-served basis. In order to provide an
enriching experience for as many eligible children as possible, partial
scholarships are given on a semester basis. For scholarship information,
please contact the administrative office.
A school year processing fee of $50 for one child ($80 for two or more
children) is required at time of registration. This processing fee is
non-refundable and non-transferable. Fees may be paid by cash,
check, money order, VISA or MasterCard. Make checks payable to
Wisconsin Youth Company.
Contact Information:
Enrollment Blackout Period
A registration blackout period will begin on August 18, two weeks
prior to the start of the school year to allow time for heavy volume of
processing. Only forms received before this period will be processed
and confirmed to begin the first week of school as space permits.
Registrations received after school begins will be processed as volume
and capacity permit.
Dane County
Wisconsin Youth Company
1201 McKenna Blvd.
Madison, WI 53719
Waukesha County
Wisconsin Youth Company
1800 Dolphin Drive Suite 200
Waukesha, WI 53186
608-276-9782 or 800-238-1174
Fax: 608-276-4050
262-547-8770 or 800-552-8878
Fax: 262-547-0394
Inclement Weather
Information can be obtained by contacting the administrative office
or visiting our website, www.wisconsinyouthcompany.org.
There is no credit or fee reduction for weather related closings.
Program related questions:
Dane: [email protected]
Waukesha: [email protected]
Billing and account information questions:
Dane & Waukesha: [email protected]
Part IA
WYC Company School Year 2014-2015: Registration Form
__________________________________________
Child’s Name
________
Gender
_________________
Grade in Fall 2014
______________
Birthdate
______
Age
______________________________________
School Attending in Fall 2014
_____________________________________ _____________________________________
Name of Primary Account Holder
Relationship to child
______________________________________________
Start Date
______________________________________________
Program Location (if different from school location)
_____________________________________ _____________________________________
Name of Secondary Contact Person Relationship to child
___________________________________________________________________________
_________________________________________________________________________
Address Address
_____________________________________________
City/State/Zip
___________________________
Home Phone
___________________________________________ ____________________________
City/State/Zip
Home Phone
Cell
Work Home
Cell
Work Home
_________________________ ________________________ _______________________
________________________ ________________________ _______________________
Work Phone
Cell Phone
Best Phone # During Program Hours Work Phone
Cell Phone
Best Phone # During Program Hours
___________________________________________________________________________ __________________________________________________________________________
Best Address During Program Hours
Best Address During Program Hours
___________________________________________________________________________ __________________________________________________________________________
E-mail Address
E-mail Address
Child resides with:
 Mother  Father  Guardian
Child previously attended the 2013-2014 AFTER SCHOOL program:
 Yes  No
Summer 2014 program:
 Yes  No
Emergency Contact/Pick-up Authorization Information: (For safety, any changes during the school year must to be made in writing to the administrative office.)
Authorized pick-up persons may be asked to present a photo I.D. All individuals authorized to pick up must be 18 years of age. Parents wanting anyone under
18 years of age to pick up their child must select the independent departure option below. Primary and secondary contacts listed above are considered
authorized pick-up persons and emergency contacts unless otherwise noted.
In addition to primary and secondary persons listed above, list a minimum of one emergency contact (REQUIRED). In an emergency, if no contact can be
made to those listed here, the police department may be notified. Add additional authorized pick up persons here, if applicable.
Name
(First & Last)
Best Phone # During Program Hours
Complete Home Address
Relationship to Child
Emergency
Contact Person
Authorized
Pick-up Person
Independent Arrival / Departure Authorization: Please check below the arrival/departure authorization applicable to your child’s enrollment. For safety,
any changes during the school year must be made in writing to the administrative office. Please give a specific time for arrival and departure times, if applicable.
Before School
Not applicable
Arrival: I acknowledge my child will:
arrive with a parent or another adult authorized to sign-in my child. (must be 18 years old)
arrive independently by walking or biking - a.m. arrival time: ___________________
Departure: I acknowledge my child will:
depart independently from program to his/her school classroom
After School
Not applicable
Arrival: I acknowledge my child will:
walk from his/her classroom to the AFTER SCHOOL program location
arrive independently by walking or biking from _______________________________________ (location) at _______________ (time)
arrive by alternate transportation from _______________________________________ (school) at _______________ (time)
Departure: I acknowledge my child will:
wait for an authorized pick-up person. (List additional authorized pick-up persons other than mother/father/guardian(s) above. Unless otherwise noted,
mother/father/guardian(s) listed above are considered authorized pick-up and emergency contact persons.) (must be 18 years old)
depart independently by walking or biking - p.m. departure time: ___________________
Office Use Only - Fees: Processing _______________ Deposit ______________ Amt Pd ______________ Ck #______________ Date Received ______________ Received by _______________
White: Administrative Copy
Yellow: Parent Copy
14-15 AS - Registration Form Part IA.indd
Swallow
Program Location
M
T
W
TH
Before School Schedule
F
For Office Use Only: Confirmed Start Date ________ /_________ /________
Tuition assistance may be available for families in need of
short term financial help to pay their child’s tuition. Please
contact the administrative office or check our website
www.wisconsinyouthcompany.org for more information.
*First child is considered the one with the most days.
See parent handbook for additional information regarding fees,
available at www.wisconsinyouthcompany.org.
Swallow
School
District
Swallow
Waukesha County AFTER SCHOOL
Grade:
T
W
F
2
3
6
7
$140.50
$53.50
$113.50
$37
$81.50
4 Days - AFTER SCHOOL
3 Days - BEFORE SCHOOL
3 Days - AFTER SCHOOL
2 Days - BEFORE SCHOOL
2 Days - AFTER SCHOOL
Intake Initials ___________________________
Total Bi-Weekly Fees
$
$
$
$69.50
$31.50
$97
$45.50
$119.50
$59
$137.50
$71.50
2nd Child Discount Fee
14-15 AS - Registration Form Part IB_Swallow.indd
Confirmation Date ______________________
$80 for two or more children
$50 for one child
$69.50
4 Days - BEFORE SCHOOL
$161.50
1st Child Fee*
5 Days - AFTER SCHOOL
(Required at time of registration.)
8
Bi-Weekly Enrollment Fees
5
$84.50
4
5 Days - BEFORE SCHOOL
Enrolled Week Days
1
A School Year Processing Fee
TH
Date Received _________________________
M
K
Child’s Date of Birth: ______________________________________________
Child’s Name: _____________________________________________________
After School Schedule
Part IB WYC School Year 2014-2015: Program Selection Form
Part II
WYC Health History & Emergency Care Plan Form
Page 1 of 2
Directions: Please complete this form entirely. A review by parents/guardians and staff is required annually. This form remains with your
child’s program during the hours your child is present in the care of Wisconsin Youth Company staff.
Child Information:
___________________________________________________________________________________________________ _________________________________________
Child’s Name (Last)
(First)
(Middle)
Birthdate (MM / DD / YYYY)
___________________________________________________________________________________________________ _________________________________________
Home Address (Street, City, State, Zip Code)
Date – First Day of Attendance (MM / DD / YYYY)
___________________________________________________________________________________________________ _________________________________________
Parent Name (Last)
(First)
Best Phone # During Program Hours
______________________________________________________________________________________________________________________________________________
Address (if different from child’s)
Physician / Medical Facility Information:
_________________________________________ ___________________________________________________________________________________________________
Name of Physician
Name, Address and Phone Number of Medical Facility
Sunscreen/Insect Repellent Authorization:
Sunscreen (Check 1 box) - Wisconsin Youth Company will provide Rocky Mountain SPF 30 sunscreen.
I authorize the use of Rocky Mountain SPF 30 sunscreen for my child to self-apply to the extent possible, and WYC staff is authorized to provide assistance in
applying sunscreen as necessary to ensure adequate coverage.
I will provide sunscreen for my child to self-apply to the extent possible, and WYC staff is authorized to provide assistance in applying sunscreen as necessary
to ensure adequate coverage.
I do not authorize my child to use sunscreen during program hours.
Insect Repellent (Check 1 box) - Wisconsin Youth Company will provide Cutter All Family Pump Spray 7% deet.
I authorize WYC staff to apply Cutter Family Pump Spray (7% Deet) to my child.
I will provide insect repellent for WYC staff to apply to my child.
I do not authorize the use of insect repellent on my child during program hours.
Immunization History: List the month/day/year the child recieved each of the following immunizations. Please fill in all empty boxes required by state law. If you do not have an immunization
record for your child, contact your doctor or local public health department to obtain the records. Visit https://www.dhfswir.org/PR/clientSearch.do?language=en and enter your child’s name and
social security number for a state immunization record for your child.
Vaccinations - required for 5 years and older
1st
2nd
3rd
4th
5th
Vaccinations - required for 4 year olds
DTP Diphtheria, Tetanus, Pertussis
DTP Diphtheria, Tetanus, Pertussis
Polio (IPV)
Polio (IPV)
Hepatitis B
Hepatitis B
Measles, Mumps, Rubella (MMR)
Measles, Mumps, Rubella (MMR)
Varicella (Chicken Pox)
Has the child had Varicella (chicken pox)
disease? If yes, vaccine not required.
Year: _________
If no or unsure, vaccine required.
Varicella (Chicken Pox)
Has the child had Varicella (chicken pox)
disease? If yes, vaccine not required.
Year: _________
If no or unsure, vaccine required.
1st
2nd
3rd
4th
Hib (Haemophilus Influenzea Type B)
Pneumococcal Conjugate Vaccine
IF THE CHILD MEETS ALL REQUIREMENTS sign at arrow below and return this form to Wisconsin Youth Company, OR
IF THE CHILD DOES NOT MEET ALL REQUIREMENTS check appropriate box below, sign and return this form to Wisconsin Youth Company.
Although the child has not received all required doses of vaccine for his or her age group, at least the first dose of each vaccine has been
received. I understand that it is my responsibility to obtain the remaining required doses of vaccines for the child WITHIN ONE YEAR and to
notify Wisconsin Youth Company in writing as each dose is received.
NOTE: Failure to stay on schedule or report immunizations to Wisconsin Youth Company may result in court action against the parents
and a fine up to $25.00 per day of violation.
For health reasons this child should not receive the following immunizations, (List in chart above any immunizations already received.): ________________
Physician’s Signature: _________________________________________________________
For religious reasons this child should not be immunized. (List in chart above any immunizations already received.)
For personal conviction reasons this child should not be immunized. (List in chart above any immunizations already received.
___________________________________________________________________________________________________ _______________________
Signature of Parent / Guardian
Date
WYC Health Histrory & ER Care Plan Form_Summer 2014 & Sch Yr 14-15.indd
Page 2 of 2
Directions: Please complete this form entirely. A review by parents/guardians and staff is required annually. This form remains with your
child’s program during the hours your child is present in the care of Wisconsin Youth Company staff.
Child Name: ________________________________________________________________________
1. Special Health Information: Please check yes or no for each statement.
General Health - Does your child:
Have asthma?
Yes No
Have diabetes?
Yes
No
Have epilepsy/seizures?
Yes
No
Date of last seizure: __________________________________________________________________________
Have cerebral palsy/motor disorder?
Yes
No
Details: ______________________________________________________________________________________
Wear glasses or contacts?
Yes
No
Have ADD/ADHD?
Yes
No
Details: ______________________________________________________________________________________
Have Autism Spectrum diagnosis?
Yes
No
Details: ______________________________________________________________________________________
Have emotional/behavioral health issues?
Yes
No Details: ______________________________________________________________________________________
Have cognitive/learning disabilities?
Yes
No Details: ______________________________________________________________________________________
Have diet restrictions or special food needs?
Yes
No
Details: ______________________________________________________________________________________
Other conditions that may require special care?
Yes
No
Details: ______________________________________________________________________________________
Food/Milk
Yes
NoDetails: ______________________________________________________________________________________
Medication(s)
Allergies - My child is allergic to:
Yes
NoDetails: ______________________________________________________________________________________
Environmental allergens (Insect stings, hay fever) Yes
NoDetails: ______________________________________________________________________________________
Other
Yes
NoDetails: ______________________________________________________________________________________
My child will have an Epi Pen at site.
Yes
No
My child will have an inhaler at site.
Yes
No
My child will have other medication at site.
Yes
No
Medications:
Medication name(s): _________________________________________________________________________
2. Signs or symptoms to watch for, please specify.
3. Specify triggers that may cause problems and steps WYC staff should follow in response.
4. Identify any WYC program staff to whom you have given specialized training/instructions to help treat symptoms.
5. I have reviewed the activities of the program and feel my child can participate without restrictions:
If no, my child can participate with the following restrictions or accommodations.
Yes
No
6. Medications (prescribed and over-the-counter) your child takes regularly between the hours of 6:30 a.m. and 6 p.m. Please list the name of
medication and the time of day to be administered.
7. When to call parents regarding symptoms or failure to respond to prescribed treatment:
8. When to consider that the condition requires emergency medical care or reassessment.
9. Does your child receive additional support services or one-on-one support during the school year?
Yes
No If yes, please explain.
In the event my child becomes ill or injured, I understand every effort will be made to reach me or an emergency contact person on file. I give my
consent for Wisconsin Youth Company to act on my behalf to obtain emergency care and treatment if it is deemed necessary.
___________________________________________________________________________________________________ _______________________
Signature of Parent / Guardian
Date
WYC Health Histrory & ER Care Plan Form_Summer 2014 & Sch Yr 14-15.indd
Part III WYC School Year 2014-2015: Payment of Fees & Account Security Policies Form
Child’s Name ___________________________________________________________________________________________________________________
Payment of Fees
1. I understand the processing fee is non-refundable and non-transferable.
2. I understand this agreement is for the entire 2014-2015 school year; and agree to make full bi-weekly payments.
3. I understand payments are due every other Monday as scheduled; fees will not be pro-rated if my child starts, changes schedule or withdraws from
program within a billing period.
4. I understand if I am receiving financial assistance, I am responsible for any amount not covered by my funding source. Written verification from my
funding source must be on file in the administrative office prior to my child’s attendance. I understand that I will be responsible for full payment until
funding documentation is received by the administrative office. I understand WYC is not responsible for contacting account holders when co-pay
amounts change by funding source. My financial assistance source is: (if applicable) Source/Contact Person: _________________________________________________________________________________ Phone #: _______________________________
5. I understand a billing fee of $20 will be assessed if payments are not received by the scheduled Monday due date.
6. I understand fees not paid by the due dates may result in my child’s removal from the program.
7. I understand I do not receive adjustment in fees for holidays, school closures or days missed.
8. I understand that my bi-weekly payments do not include charges for school year winter and spring break weeks.
9. I understand a $30 charge is assessed for each Non-Sufficient-Funds (NSF) check or declined credit card transactions.
10. I understand a $25 late fee will be assessed for every 15 minute increment, or portion thereof, that I am late to pick up my child, after program closing
time.
11. I understand that only those persons signing this agreement and providing the account password will have authority to access and make changes to
this account. I understand that only those persons signing this agreement will be considered account holders, having full account access. I
understand that parent / guardian (account holder(s) may designate additional authorized account user(s) who may receive account information, but
not make any changes to account or registration information.
12. Requests for duplicate mailings to a second address are available for a $15 annual fee (2014-2015 program year).
13. I understand that any remaining and past due balances to my account will be charged to my credit card on file on the next pay cycle.
Signature: _______________________________________________________________________________________________ _______________________________
(Account Holder) Date
Account Access Password - Required
The security of your enrollment information is important and we’ve taken steps to help keep it secure. When enrolling your child, you are required to create
a unique password and answer at least one security question listed below. This verification is REQUIRED whenever you or someone you authorize calls or
emails us regarding your information (i.e. balance due, pick-up persons) and whenever account holders submit written requests and information updates so
that we can protect your privacy and only give the information out to you or the person you designate. We can ONLY provide enrollment information when
the correct PASSWORD and/or SECURITY ANSWER are provided by an authorized user. You may choose to keep your same password from previous
Wisconsin Youth Company programs; however, you must confirm the password below.
Please give us a password and the answer to at least one of the security questions listed below.
Account Access Password ______ ______ ______ ______ ______ ______ (Maximum: 6 characters)
Security Questions (Please answer at least one of the following.):
1. What street did you live on during high school? _____________________________________________________________
2. Who was your childhood hero? ______________________________________________________________________
3. What is your Grandmother’s maiden name? _________________________________________________________
Account Access - Optional
In order to protect your privacy, we are unable to provide information to anyone other than an account holder or authorized user. An account holder is
anyone who has signed the registration agreement. Account holders are liable for the account, are able to request information and are able to make
changes to the account. Authorized users are individuals authorized by the account holder to access information only. As the account holder, you may
authorize other individuals (e.g. a spouse and/or other parent) by listing their name(s) below. Authorized account holders must sign registration
agreement form.
I authorize the following person(s) to be an authorized user, allowing him/her to access information on the account:
___________________________________________________________________________________________________________________________________________________
Additonal Authorized User Name - Print
I authorize the following person(s) to become an account holder, allowing him/her to make changes to account information: ___________________________________________________
________________________________________________________ ___________________________
Additonal Authorized Account Holder Name - Print Signature of Additonal Authorized Account Holder Date
Authorized Account Holder’s Name and Signature - Required
___________________________________________________
_________________________________________________ __________________________________
Account Holder Name - Print Signature of Account Holder - Required Date
White: Administrative Office Copy Yellow: Parent Copy 14-15 WYC: Payment of Fees & Account Security Policies Form.indd
Part IV
WYC School Year 2014-2015: Registration Agreement
Child’s Name (Please print): ________________________________________________________________________________
Program Location: _________________________________________________________________________________________
Attendance Schedule
1. I understand I must notify the AFTER SCHOOL message center in the event my child will not attend or will be late on a scheduled day.
Repeated failure to notify of absence may result in additional fees.
2. I understand I may change my child’s schedule by giving advance written notice. Written notice must be given to the administrative office by
the end of the business day Friday six business days prior to the billing period for which the change is requested. Requests involving an
increase of days are on a space-available basis. If schedule changes exceed three per year, a $5 charge will be assessed for each
subsequent change. Changes to enrolled days cannot be made effective mid-billing period. AFTER SCHOOL cannot honor requests
to switch a scheduled day with non-enrolled day.
3. I understand if space permits, my child may attend an added day (a day not regularly scheduled) for an additional non-refundable and
non-transferable fee. I am required to request an added day through the administrative office no more than two weeks in advance. 4. I understand AFTER SCHOOL will make every effort to provide reasonable modifications that will accommodate the needs of children within
the limitations of program sites, maintain required staff ratios, program resources and the safety of all children in program.
Parental Consent
1. I give my consent for my child’s participation in any field trips scheduled as part of his/her enrollment and consent for my child to be
transported to and from any scheduled program activity for which transportation is provided. I understand AFTER SCHOOL adheres to state
licensing regulations and organization policy regarding supervision of children and transportation while on all trips.
2. If enrolled in the before school program, I give my consent for my child to leave for class unescorted.
3. If enrolled in the after school program, I give my consent for my child to arrive at program unescorted at the end of the school day.
4. I understand that if I give permission for my child to arrive/depart independently from his/her program site (as indicated on the registration
form) that I must inform the administrative office in writing of any changes in his/her arrival/departure procedures.
For Madison Program Locations Only:
Madison program sites are accredited by the City of Madison. During this review and evaluation process, children’s relevant information may be
used to improve the quality of the program and support for the child. This is a voluntary authorization and does not affect enrollment.
Yes, I hereby authorize the release of confidential information of my child to the Madison Accreditation Program.
No, I do not authorize the release of confidential information of my child to the Madison Accreditation Program.
Agreement Signature - I/We understand and agree to abide by the above policies and other WYC policies as stated in
the parent handbook. Handbook is available online or in print.
___________________________________________________
Parent / Guardian - Please Print Name
___________________________________________________
Additonal Authorized Account Holder Name - Print
____________________________________________________ ______________________
Signature of Parent / Guardian
Date
____________________________________________________ ______________________
Signature of Additonal Authorized Account Holder
Date
Photo Release
I grant Wisconsin Youth Company (WYC) permission to publish my child’s image in its newsletters, brochures, displays or other printed material
and on its websites for purposes of promoting the programs. I understand that children’s names are not used when their images are displayed
on our website or in widely distributed print materials. I understand that if I request, in writing, removal of my child’s image from WYC’s
websites, his/her image will be removed no later than 15 days from receipt of my request. Also, I release WYC, its employees, officers, directors
and successors from any liability or claim related to the publication or disclosure for which I have hereby granted permission. I understand that
the consent I grant here is completely voluntary.
Yes, I accept the photo release.
No, I do not accept the photo release.
I agree to photo release for program site use only (e.g., bulletin boards in room, art projects or newsletters).
Yes, I accept the photo release
No, I do not accept the photo release.
_____________________________________________________________________________________ ___________________________
Signature of Parent / Guardian (Account Holder) Date
White: Administrative Office Copy Yellow: Parent Copy
14-15 WYC: - AS Agreement.Indd
WYC Credit/Debit Card Authorization Form - Optional
Child(ren)’s Name(s) ________________________________________________ Program ____________________________
Wisconsin Youth Company Primary Account Holder _________________________________________________________
Mother / Father / Guardian (circle one)
Card Type:
Visa
MasterCard
Credit Card # ________________ ________________ ________________ ________________
Exp. Date _____________ / _____________ CVC2 Code ___________________
(3 digit number on back of card)
Name on Card ______________________________________________________________________________________________________________
Street Address _________________________________________________________________________________ Zip Code ___________________
Email Address ____________________________________________________________ Phone Number ___________________________________
(Please indicate authorization by selecting corresponding boxes below and see payment calendar for processing dates.)
I authorize autopay charges to the credit card listed above for:
(First payment(s) will be charged to this card upon processing.)
Summer 2014 - fees occurring June 2014 through August 2014. (autopay processed weekly)
School Year 2014-2015 - fees occurring September 2014 through June 2015. (autopay processed monthly)
I authorize a one time charge of $ ________________ to the credit card listed above for:
Summer 2014
School Year 2014-2015
Signature ___________________________________________________________________________ Date __________________________
Authorization by phone: Intake Initials _____________ Date ______________
OFFICE USE:
White: Administrative Office Copy
Date Processed: ___________________
Yellow: Parent Copy
Initials: ___________________
Email / Invoice / Receipt: P1 / P2
WYC Credit-Debit Card Authorization Form_14.indd
DEPARTMENT OF CHILDREN AND FAMILIES
Division of Early Care Regulation
dcf.wisconsin.gov
YOUR GUIDE TO REGULATED CHILD CARE
Your summary of the child care rules
TYPES OF REGULATED CHILD CARE PROGRAMS
Licensed Family Child Care Centers
A program regulated under DCF 250 where a person provides care and supervision for less than 24 hours per day for at least 4 and not more
than 8 children who are not related to the provider.
Age groups may be mixed according to the following combinations. Additional allowed school-aged children in care for 3 or fewer hours per
day are shown in parentheses.
Children Under Age 2
0
1
2
3
4
+
+
+
+
+
Children Age 2 and Older
8
7
5
2
0
+
+
+
+
+
School Age Children
(0)
(0)
(1)
(3)
(2)
=
=
=
=
=
Maximum Group Size
8
8
8
8
6
Licensed Group Child Care Centers
A program regulated under DCF 251 where a person for less than 24 hours per day provides care and supervision for 9 or more children who
are not related to the provider.
Age of Children
Staff-To-Child Ratio*
Birth to 2 yrs
1:4 or .25
2 yrs to 2½ yrs
1:6 or .167
2½ yrs to 3 yrs
1:8 or .125
3 yrs
1:10 or .10
4 yrs
1:13 or .077
5 yrs
1:17 or .059
6 yrs and over
1:18 or .056
* These ratios are adjusted for mixed age groups
Maximum Group Size
8
12
16
20
24
34
36
Licensed Day Camps for Children
A program regulated under DCF 252 that provides care and supervision to 4 or more children, 3 years of age and older, in a seasonal
program oriented to the out-of-doors for periods less than 24 hours per day.
Certified Family Child Care
A program regulated under DCF 202 where a person provides care and supervision for less than 24 hours per day for no more than 3 children
under age 7 with a maximum group size of 6, including the provider’s own children under age 7.
Certified School-Age Programs
A group child care center certified under DCF 202 to provide care and supervision to school-aged children aged 7 and older.
A WORD ON WISCONSIN CHILD CARE REGULATIONS
Anyone providing care and supervision for 4 or more children under age 7 years for less than 24 hours a day must be licensed by the
Department. Exceptions to this rule are:
• A parent, grandparent, great-grandparent, stepparent, brother, sister, first cousin, nephew, niece, uncle, or aunt of a child, whether by
blood, marriage, or legal adoption, who provides care and supervision for the child.
• Public and parochial schools.
• Care provided in the home of the child’s parent for less than 24 hours per day.
• Counties, cities, towns, school districts and libraries that provide programs for children primarily intended for social or recreational
purposes.
• A program that operates not more than 4 hours per week.
• Group lessons to develop a talent or skill such as dance or music, social group meetings and activities, group athletics.
• A program where the parents are on the premises and are engaged in shopping, recreation or other non-work activities.
• Seasonal programs of ten days or less duration in any 3-month period, including day camps, vacation bible school and holiday child care
programs.
• Emergency situations.
• Care and supervision for no more than 3 hours a day while the parent is employed on the premises.
• A program provided where the child of a recipient of temporary assistance to needy families, or Wisconsin works, is involved in
orientation, enrollment or initial assessment or where parents are provided training or counseling.
Regulations set standards for adequate child care, but they cannot guarantee quality care. That is why parent involvement is so crucial.
IF YOU HAVE QUESTIONS, CONCERNS OR COMPLAINTS
First, talk to your child’s caregiver and try to work out your differences. If those attempts fail, and you feel the caregiver is violating a state
licensing regulation, contact the appropriate regional office. See http://dcf.wisconsin.gov/childcare/licensed/contact.htm or call 1-800-3627353 for contact information. If you feel the caregiver is violating certification rules, contact the appropriate certifying agency. See
http://dcf.wisconsin.gov/childcare/certification/pdf/certifiers.pdf for the certifying agency in your county or call 608-267-2079 for contact
information.
DCF-P-2436 (R. 01/2012)
DCF-P-2436 (R. 01/2012)
Are the play areas clean and large enough so children can move freely and safely?
Is the playground safe and supervised by an adult?
Is play equipment sturdy and in good repair?
Are games, toys, etc. stored where the children can get to them?
Are wall displays placed at child’s eye level?
Are unused electrical sockets covered with safety caps?
Are cleaning fluids, medications, poisons, sharp tools, matches, etc. stored away from
children?
Is the area free of other hazards: peeling paint, exposed electrical wires, uncovered
hot water pipes, unprotected hot radiators or heaters?
Are fire safety and tornado drills practiced?
Are emergency telephone numbers posted by the telephones?
Is there adequate heat, ventilation and lighting?
Are bathrooms clean and sanitary?
Are step stools in the bathrooms to help young children reach toilets and sinks?
Physical environment
Do they get down to eye level when talking to or listening to the children?
Do they encourage the children to express their feelings verbally?
Do they encourage children to work out negative feelings without hurting others?
Do they respect individual differences among the children?
Do the child guidance measures focus on what the child should do rather than what the
child should not do?
Do they set reasonable limits and allow children to make choices when appropriate?
Do they provide guidance with words, tone of voice and actions that show respect for
children? Note: See licensing and certification rules for prohibited punishments.
Do they show patience by letting children do things for themselves and exert their
independence?
Do the children seem comfortable when talking to the caregivers?
Do the children seem happily occupied and relaxed?
Does the ratio of children to caregivers meet state requirements?
Caregiver / child interaction
Do they genuinely seem to enjoy working with young children?
Do they seem to be warm, loving people?
Do they talk with you openly and straightforwardly about their policies?
What training and experience do they have? Do they receive regular, ongoing jobrelated training?
Do they seem to get along well with each other?
Caregivers
The Department of Children and Families (DCF) is an equal opportunity employer and service provider.
If you have a disability and need to access this information in an alternate format, or need it translated
to another language, contact the Bureau of Early Care Regulation at (608) 266-9314 (general) or (888)
692-1382 (TTY). For civil rights questions call (608) 266-5335 or (866) 864-4585 (TTY).
Is the license / certificate posted?
Are visits by the parents, whether announced or unannounced, welcome at any time?
Are there opportunities for parent / caregiver communication?
Is this the kind of place you would enjoy spending your day?
Are the results of the most recent licensing visit posted?
Do staff and children wash their hands before meals and after toileting or diapering?
Are meals and snacks well balanced and wholesome?
Is the food preparation area clean and sanitary?
Are menus posted in licensed programs?
General things to look for
Are vehicles used to transport children insured, and does the center’s policy address
insurance coverage for transportation?
Are vehicles in safe operating condition?
Are appropriate individual child car safety seats and booster seats used?
Does the center have a procedure to ensure that no child is left unattended in a
vehicle?
Do vehicles with a seating capacity of 6 or more passengers in addition to the driver
have a vehicle alarm installed to ensure no child is left unattended in a vehicle?
Transportation
Is there a regular daily schedule? Is it organized without being rigid?
Are activities geared for different age and developmental levels?
Are there indoor and outdoor activities?
Is time provided for physical activity and quiet play?
Is there a nap or rest period?
Are there structured activities as well as free play when children can choose what to
do?
Are there opportunities for different types of interactions—large group play, small group
play, alone time?
Are there materials for different types of play—drama, music, creative movement,
language skills, gross and fine motor skills, art projects, sand and water play?
Are there living plants for children to observe and care for?
Are there pets in areas of the center accessible to children? Have pets been
appropriately vaccinated? Are pets tolerant of children? Is close supervision
provided?
Are the children taken out into the community for activities—parks, libraries, museums,
field trips? Is there adequate supervision?
Program / Activities
WHAT IS QUALITY CHILD CARE?
That question has no easy, quick answer. Evaluating child care may seem an overwhelming task, especially if you are new to child care services. This checklist can help. For a thorough
evaluation, go through the entire checklist section by section, or, if you prefer, focus on the parts that seem most important to you. YoungStar is a program of the Department of Children
and Families created to improve the quality of child care for Wisconsin children. To search for safe, quality child care in Wisconsin, see the Regulated Child Care and YoungStar Public
Search page http://childcarefinder.wisconsin.gov/Search/BasicSearch.aspx
Page 2 of 2
This brochure explains how to qualify
and apply for assistance from
Wisconsin Youth Company. It also
lists additional funds and resources
available to families.
The Wisconsin Youth Company
Tuition Assistance Fund
www.wisconsinyouthcompany.org
Waukesha County Office
1800 Dolphin Dr. Suite 200
Waukesha, WI 53186
262-547-8770 or 800-552-8878
Fax: 262-547-0394
Dane County Office
1201 McKenna Blvd.
Madison, WI 53719
608-276-9782 or 800-238-1174
Fax: 608-276-4050
Wisconsin Youth Company, Inc.
Children are defined as K-12 with highest
priority for K-8 in Dane and Waukesha
Counties.
● Children benefit from educational support
and enrichment resources.
● Children benefit from resources that
encourage the exploration and pursuit of
their individual interests.
● Children benefit from encouragement and
support for community engagement.
● Children value themselves, others and their
environment.
● Children benefit from regular interaction
with caring and positive adult role models.
● Children benefit from safe and secure
places to be a child outside home and
school.
Wisconsin Youth Company exists so that the
children of Wisconsin benefit from communities
that nurture them, at a sustainable cost.
Wisconsin Youth Company
Ends Statements
Tuition Assistance Fund
and Other Funding or
Support Opportunities
for Families
Obtain a tuition assistance fund application
from the Wisconsin Youth Company office
in Madison, 1201 McKenna Blvd., Madison,
WI 53719, 608-276-9782 or 800-238-1174 or
in Waukesha, 1800 Dolphin Dr. Suite 200,
Waukesha, WI 53186, 262-547-8770 or 800552-8878. Return the application with your
school authorized signed free or reduced meal
eligibility form. The annual registration fee, all
day programs and late fees are not covered by
scholarship funds.
How to Apply
If your child is eligible for free school meals you
may qualify for a 50 percent scholarship per
semester. If your child is eligible for reduced
cost meals you may qualify for a 25 percent
scholarship for one semester. You may also
qualify for a 50 percent scholarship or a 25
percent scholarship for one week of summer
day camp, Wander Wisconsin or Middle
School U.
What We Provide
If your child is eligible for free or reduced cost
meals in the public schools you may qualify
for a scholarship. You must first apply for the
meal program assistance through your child’s
school. All parents or guardians receive an
application for free or reduced cost meals at
public school enrollment. You may also request
an application from your child’s school office.
How to Qualify
While we would like to help all the families
who apply, the fund is very limited.
The Wisconsin Youth Company Tuition
Assistance Fund is for families in need of short
term financial help in order to pay their child’s
tuition for before or after school care or
summer camp.
The Wisconsin Youth Company
Tuition Assistance Fund
The Child Care Tuition Assistance Program (CCTAP)
is designed to provide financial assistance for child
care tuition to income eligible students who are
parents. All students who are enrolled for graded
academic credits at the University of WisconsinMadison and who pay segregated fees may
apply. For more information contact the Office of
Child Care and Family Resources, 608-265-9662
or visit www.occfr.wisc.edu/cctap.htm.
In Madison the Child Care Assistance Program
is operated through the City of Madison Office
of Community Services. This program provides
financial assistance to low income families living
in Madison who are working, looking for work or
attending training or going to school. Families
may also qualify if their child has special needs
or if they are experiencing a family emergency.
To receive tuition assistance from this program
you must enroll your child in a city accredited
program. Wisconsin Youth Company (WYC)
school-year programs located in the City of
Madison are state licensed and city accredited.
WYC summer day camp programs located in the
City of Madison are state licensed and accredited
by the American Camp Association. For
information about eligibility visit www.ci.madison.
wi.us/commserv/communityTAP.html or call
608-266-6520 or 608-267-4996.
The Wisconsin Shares Child Care Subsidy Program
is a state program operated through the Wisconsin
Department of Children and Families that helps
qualified families pay for child care. Through this
program families pay a share for child care that
is based on a sliding scale and is determined
by income, family size and the child care
service chosen. For eligibility requirements and
other information visit www.dcf.wisconsin.gov/
childcare/wishares. In Dane County call the Dane
County Job Center, 608-242-7441. In Stoughton
call 608-873-5636. In Waukesha County call the
Arbor Education and Training Office, Pewaukee,
262-695-7925.
Other Funding Sources
Wisconsin Youth Company sponsors a youth
and family center in its administrative building
on McKenna Blvd, in Madison. The center
offers a free state-licensed after school child
care program for qualifying families who live
in the Greater Elver Park neighborhood. The
center also houses programs for middle and
high school youth. It is funded by the City of
Madison Commumity Services, Dane County
and Community Development Block Grants.
For more information contact the WYC
administrative office, 608-276-9782.
Wisconsin Youth & Family Center
Visit www.supportingfamiliestogether.org and
click on CCRR. That will bring up a listing of
child care resource and referral agencies by
county. Both Dane and Waukesha counties
where Wisconsin Youth Company programs
are located have child care resource and
referral agencies. You may also contact
them by phone 608-224-5341.
This organization was created in 2007 with the
merger of the Wisconsin Child Care Resource
and Referral Network, the Wisconsin Child
Care Improvement Project and a statewide
network of family resource centers. The
WCCRR Network provides help to families
in locating regulated child care as well as
technical assistance and training to child care
providers.
Supporting Families Together
Other Resources

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