Registration
(21st CCLC / LEAP / RISE)

Form must be completed in its entirety. Incomplete forms will not be processed. Spots are limited. Students cannot attend prior to receiving acceptance notice.

*WCSD 21st CCLC will adhere to all normal WCSD COVID 19 day protocols for the safety of students and staff during the after school program.

Please select your school: *

Student's Last Name: *

Student's First Name: *

Student's Middle Initial: *

Student's Date of Birth: * +

Student's ID (Lunch Number): *

IMPORTANT: Students cannot attend prior to receiving acceptance notice.

See additional requirements and policies at the end of this form.

Demographics

Grade: *

Gender: *

Female

Male

Primary Language: *

English

Spanish

Other Other

Address Information

Address: *

City: *

State: *

Zip Code: *

Parent E-mail: *

Registration(21st CCLC / LEAP / RISE)

Registration
(21st CCLC / LEAP / RISE)