Childcare
Please fill out the following survey if your family is in need of childcare between now and April 24 due to the school closures.
Do you need childcare with school closure until April 24?
*
Yes
No
Is your family currently enrolled in emergency childcare with Champions or YMCA?
*
Yes
No
I will need support on the following days:
*
Monday
Tuesday
Wednesday
Thursday
Friday
How many elementary students do you need childcare for?
*
1
2
3
4
Other
Student name?
*
First Name
Last Name
Student ID number
Student's school
*
Arrowhead
Bear Creek
Canyon Creek
Cottage Lake
Crystal Springs
East Ridge
Fernwood
Frank Love
Hollywood Hill
Kenmore
Kokanee
Lockwood
Maywood Hills
Moorlands
Shelton View
Sunrise
Wellington
Westhill
Woodin
Woodmoor
Other
Grade
*
K
1
2
3
4
5
Student Two
Student name?
*
First Name
Last Name
Student ID number
Student's school
*
Arrowhead
Bear Creek
Canyon Creek
Cottage Lake
Crystal Springs
East Ridge
Fernwood
Frank Love
Hollywood Hill
Kenmore
Kokanee
Lockwood
Maywood Hills
Moorlands
Shelton View
Sunrise
Wellington
Westhill
Woodin
Woodmoor
Other
Grade
*
K
1
2
3
4
5
Student Three
Student name?
*
First Name
Last Name
Student ID number
Student's school
*
Arrowhead
Bear Creek
Canyon Creek
Cottage Lake
Crystal Springs
East Ridge
Fernwood
Frank Love
Hollywood Hill
Kenmore
Kokanee
Lockwood
Maywood Hills
Moorlands
Shelton View
Sunrise
Wellington
Westhill
Woodin
Woodmoor
Other
Grade
*
K
1
2
3
4
5
Student Four
Student name?
*
First Name
Last Name
Student ID number
Student's school
*
Arrowhead
Bear Creek
Canyon Creek
Cottage Lake
Crystal Springs
East Ridge
Fernwood
Frank Love
Hollywood Hill
Kenmore
Kokanee
Lockwood
Maywood Hills
Moorlands
Shelton View
Sunrise
Wellington
Westhill
Woodin
Woodmoor
Other
Grade
*
K
1
2
3
4
5
Cost of the YMCA and Champions emergency childcare is $45 a day. Do you need a scholarship?
Yes
No
Are you essential personnel for your role (health care, emergency, grocery, pharmacy, etc.)?
Yes
No
Please rank your preferred locations:
Canyon Creek
Cottage Lake
Lockwood
Northshore YMCA
First Choice
Second Choice
Third Choice
Are you currently a Champions customer?
Yes
No
Are you currently a YMCA customer?
Yes
No
Name of parent or guardian
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Do you work for:
Everett Clinic
Other
Additional Comments
Save
Submit
Should be Empty: