Child's Name :

First Name
Last Name
Date of Birth

Parent/Guardian (1)

First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Parent/Guardian(2)

First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Program Choice:

Full Day Monday-Friday (up to 10 hours) After School (K-3rd; 9 months only) Summer School Age (K-3rd; 3 months only)

Desired Start Date:

-- mm/dd/yy

SA ONLY-what school does your child attend?

A non-refundable application fee of $50 must be sent to
"WHCC, 5470 Research Park Drive, Fitchburg, WI  53711"
in order for the application to be processed.

Once a spot has been offered, an additional $100 confirmation fee must be paid within one week of the accepted offer.  This fee is credited back to your tuition after 3 months of enrollment.  It is forfeited if your child does not start on the designated start date or if you leave WHCC prior to the 3 months.