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TTNC 2026-2027 After School

Please complete the information below to register for TTNC After School. Our Neighborhood Center Director will reach out to you upon receiving completed forms. For questions, contact JWeber@wisconsinyouthcompany.org.

Within registration we use the term Parents. Families are varied and the use of the word Parent(s) refers to the adult(s) who are responsible for the child(ren).

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Child Information

Participant's Full Name(Required)
Birthdate(Required)
Please enter a number from 5 to 12.

Parent Information

Parent 1 Full Name(Required)
Parent 2 Full Name
Parent 1 Address(Required)
Parent 2 Address
Participant resides with:(Required)

Special Health Information

Medical Conditions(Required)
Allergies(Required)
Epi Pen(Required)
Behavioral or Emotional Needs(Required)
Asthma(Required)
Inhaler(Required)
Medications needed during program time(Required)

Emergency Contact/Pick-Up Authorization

In addition to the primary and secondary persons listed above, list at least one emergency contact. Additional emergency contacts and authorized pickups may be added as well.
Full Name Email or Home Address Phone # Relationship to child Emergency Contact Authorized Pick-up Actions
           
There are no Entries.

Maximum number of entries reached.

I understand that an authorized pick-up person or myself must pick up my child on time or I can authorize my child to walk home from Theresa Terrace Neighborhood Center (TTNC) by checking the box below and providing your initials(Required)
Registration and Permission to Participate(Required)
1. I am aware that if my child’s participation in any Wisconsin Youth Company (WYC) program(s) for which he/she is registered requires more than reasonable accommodations, whether due to special needs or behavior, my child may be removed from the program.
2. I understand if my child has any behavorial/emotional needs, I have so indicated in the special health information section of this form.
3. In the event my child becomes ill or injured, I understand that an effort will be made to reach me or an emergency contact person on file.
I give consent for Wisconsin Youth Company to act on my behalf to obtain emergency care and treatment if deemed necessary.
4. I am aware that my child may have the opportunity to participate in field trips. I give consent for my child to participate in field trips and be transported to and from any scheduled program activity for which transportation is required.
5. I understand that WYC may contact me by email and text messaging for the purpose of communicating urgent information that involves my child’s program. I understand that I can opt-out of this service by contacting the WYC administrative office.
6. I give permission for my child or me to appear in any media coverage approved by Wisconsin Youth Company and for WYC to use photos of my child in promotional publications, flyers, social media or website.
7. I have read and understand the program description and schedule as outlined in the registration information letter.
Parent/Guardian Name
Clear Signature

Demographic Information

Collected for grant purposes only.
My child's race is:(Required)
Check all that apply
My child's ethnicity is:(Required)
Is the head of your household male or female?(Required)

Community Feedback Request

Aside from youth programs, what types of programs interest you and your family?
Select all that apply
What types of events & services interest you and your family?
Select all that apply
Have you attended our annual Back2School Block Party?
What age groups are important to your family for future programs and services offered by our center?
Select all that apply
Please select any barriers that prevent you from participating in center programs or services.
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Dane County - Mailing Address

1201 McKenna Blvd.
Madison, Wisconsin 53719
Email: info@wisconsinyouthcompany.org
Phone: 608-276-9782
Fax: 262-547-0394
Attendance Message Line: 608-276-9898
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Hartland, Wisconsin 53029
Email: info@wisconsinyouthcompany.org
Phone: 262-547-8770
Fax: 262-547-0394
Attendance Message Line: 262-547-2326
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