2015-2016 REGISTRATION FORM (age 2 years and older)
May 18, 2015 to May 20, 2016 (includes 4-K)
Helen R. Godfrey – University Child Learning and Care Center
*Stevens Point School District 4 Year Pre-Kindergarten (need to be 4 by Sept 1, 2015-no exceptions)
The center is open 7:30 AM – 5:30 PM
Child’s Name
Application Date
Home Address
City/State/Zip
Birth Date
Age
Home Phone
Sex
Parent’s Cell Phone
Parent’s Name (Guardian)
E-Mail
Status: check one
UWSP Student
Faculty/Staff
Employee ID #
# of credits
Alumni
Other
Driver’s License #
Social Security #
Parent’s Name (Guardian)
E-Mail
Status: check one
Student – Full time
Faculty/Staff
Employee ID #
Student – Part time
Alumni
Other
*Driver’s License #
*Social Security #
*All personal confidential information is retained in a highly secured location with very limited access and not further shared
Payment – Check one
Paid in full by self
County Assistance
Other, please explain
Delinquent Payments: Individuals not paying on time will be billed an additional $10.00 late fee.
A bill is considered late if it is left unpaid after a 10-day period from the billing date.
Please write in estimated arrival & departure time for each block option of your child’s weekly attendance
Days:
*(Pre-K see below)
Half Day - AM
7:30-12:30
Half Day - PM
12:30-5:30
Full Day
7:30-5:30
Full Week
7:30-5:30
No Care
Mon. (UCLCC)
Tues. (UCLCC)
Wed. (UCLCC)
Thurs. (UCLCC)
Fri.
(UCLCC)
*4-yr old Kindergarten Program □ Yes □ No no charge if 4K only from 9:00-11:40
My Child will need wrap around (before and/or after 4-K) □ Yes □ No
4- K is 5 days per week AM (9:00-11:40). Wrap around hours sign up above in HRG/UCLCC time blocks
*The 4- K: Program Starts September 1, 2015 and ends June 3, 2016 □
Please check appropriate time block(s) needed
Full Calendar Yr
Full Academic Yr ’15-‘16
May 18, 2015 to May 20, 2016
May Interim ‘15
Summer ‘15
August Interim ‘15
Semester I ’15-‘16
Winterim ‘16
Semester II ’15-‘16
May 18, 2015 - June 12, 2015
June 15, 2014 - August 7, 2015
August 10, 2015- August 28, 2015
Sept. 2, 2015 – Dec. 22, 2015
January 4, 2016- January 20, 2016
Jan. 25, 2016 – May 20, 2016
Sept. 2, 2015 – May 20, 2016
Rates Effective June 1, 2015
Registration Fees:
Initial Student
Initial Non-Student
Continuing Student
Continuing Non-Student
Summer School Age Program
$50.00
$75.00
$20.00 per semester
$25.00 per semester
$75.00 new enrollment, $50.00 returning
Children 2 and OLDER:
Hourly
Half Day - AM
Half Day – PM
7:30-12:30
12:30-5:30
Student Rate
$10.00
30.00
30.00
Non-Student Rate
N/A
40.00
40.00
School Age (May Interim, Summer & August Interim ONLY):
Full Day
7:30-5:30
35.00
45.00
Full Week
7:30-5:30
160.00
200.00
Half Day - AM
Half Day - PM
Full Day
Full Week
7:30-12:30
12:30-5:30
7:30-5:30
7:30-5:30
Student Rate
25.00
25.00
30.00
125.00
Non-Student Rate
35.00
35.00
40.00
155.00
Minimum Care: HRG-UCLCC allows a minimum enrollment of two (2) half days or two (2) full days sessions per week
for non-students. *Special considerations made on a case by case basis outside the minimum care requirement.
Family Discount: Additional children from the same family receive 10% off the lowest rate on the 2nd child and each
subsequent one thereafter.
Student ONLY Pick up Window: Students have a 15 minute “grace” window after their scheduled pick up time to get
to the center. This does not apply after the 5:30 closing time of the center. Be sure to schedule appropriate time for
drop off and transitioning into the center with and for your child. If you have questions about how to make the
morning transitions go smoothly for both you and your child, our staff has lots of experience and we’re happy to help.
4K Wrap Around Care: This is care that either occurs before or after 4k that we will happily work with you to contract.
This helps us provide consistency in staffing and enhances the child’s sense of predictability, fewer transitions, and
provides excellent educational enhancement for those who receive this value added care following 4K. All care before
9:00 and after 11:40 is considered wrap around hours and there are changes for these services. For children needing
any wrap around care for times when they are not in the 4K program, we offer an hourly rate as well as time around
the AM/PM Full day sessions. We are happy to talk to you about these options.
Hourly Rate 4K Wrap Around Rate:
We provide an additional hour of care before and/or directly after 4K, on a contracted basis. Per hour: $10.00 Rate
Permission: Check One
Yes
No
I give permission for my child to participate in all walking trips originating at UCLCC to points of interest on
or near campus.
I will allow my child to participate in swim groups at UWSP/UCLCC in the 8-week summer program. (Must
be 3 years old and toilet trained.)
I give permission for students enrolled in UWSP classes to do volunteer work with my child under
supervision of UCLCC staff.
Insurance Information: Is participant covered by family medical/hospital insurance? □ Yes □ No
Carrier/Plan Name ____________________________________________ Group/Policy # __________________________
Name of insured _________________________________________ Relationship to participant ______________________
By signing below, you are agreeing to all policies in the Parent Handbook, our fee schedule, and accepting responsibility
for payment of your child’s scheduled hours (unless covered by another agency). If you do not understand a policy
or procedure, please contact the director to further discuss.
_____________________________________________
Parent(s)/Guardian(s) Signature
____________________
Date