• RIVER FOREST SCHOOL DISTRICT 90 CHILDCARE & BLENDED LEARNING SUPERVISION REGISTRATION PACKET

  • To begin the registration process for the D90 Blended Learning Supervision Program, you will need to complete the registration packet and provide your child(ren)'s health exam form. You will receive an email notification that the registration packet has been received. A team member from the D90 Childcare Team will follow up to confirm when your registration has been finalized.

    This online registration form allows you to register for multiple children (up to 4) residing in the same household.

    You will need to provide your child(ren)'s health exam form. You will have an oportunity to upload with your registration packet. The form must be received prior to first day of program attendance. If you are unable to upload the form, you can email the form to D90childcare@westcookymca.org. If your child(ren) was a previous D90 participant and we have your health form on file, you do not need to resubmit.

  • Parent/Guardian 1 Information

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  • Parent/Guardian 2 Information

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  • WEST COOK YMCA PICK-UP AUTHORIZATION

  • All individuals who wish to pick up your child must be listed below. (Excluding parents and guardians listed on the general information sheet.) For the safety of your child, anyone picking up your child must have a picture I.D. Anyone without proper authorization will not be allowed to take your child.

    REQUIRED: Emergency contacts (in the case that guardians are not able to be reached during program) These Individuals are also authorized to pick up child:

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  • Authorized Additonal Pick Ups

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  • If anyone other than those listed will be picking up your child, you must contact Youth Development Program Staff via d90childcare@westcookymca.org. Phone authorization will not be sufficient. Reminder that all need photo I.D. needed for pick up authorization.

  • Student # 1 Information


  • STUDENT 1 APPROVAL FOR WEST COOK YMCA ACTIVITIES

    Please check all the appropriate boxes that you are approving or not approving and sign and date at the bottom of the page.
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  • STUDENT 1 HEALTH HISTORY FORM

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  • If your child needs medication administered to him/her during program please complete the medical distribution permission form. Please list ANY additional information about your child’s health history, behavior, and physical, emotional, or mental health about which the YMCA staff should be aware. All information given is confidential and will only be viewed by necessary YMCA staff.

  • WEST COOK YMCA SCHOOL AGE DEVELOPMENTAL HISTORY

  • Developmental and Social Experience

  • Health History and Eating Habits

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  • STUDENT 1 MEDICAL DISTRIBUTION PERMISSION FORM

  • (Only for students who will take medication during program or needs medicine, including an inhaler or Epi-pen, to be kept on-site.)

    I give the West Cook YMCA permission to administer the following medication to my child.

    • Medication must be in its original, labeled container. No medication will be accepted if not the original container.
    • The child’s name must be on the medication container.
    • The date on the prescription must be current (within 1 month for antibiotics; and within 1 year for other medications).
    • The medication’s name, dose and frequency of administration on the label must be consistent with parental instructions.
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  • Student # 2 Information

  • STUDENT 2 APPROVAL FOR WEST COOK YMCA ACTIVITIES

    Please check all the appropriate boxes that you are approving or not approving and sign and date at the bottom of the page.
  • Clear
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    Pick a Date
  • STUDENT 2 HEALTH HISTORY FORM

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  • If your child needs medication administered to him/her during program please complete the medical distribution permission form. Please list ANY additional information about your child’s health history, behavior, and physical, emotional, or mental health about which the YMCA staff should be aware. All information given is confidential and will only be viewed by necessary YMCA staff.

  • STUDENT 2 WEST COOK YMCA SCHOOL AGE DEVELOPMENTAL HISTORY

  • Developmental and Social Experience

  • Health History and Eating Habits

  • Browse Files
    Cancel of
  • STUDENT 2 MEDICAL DISTRIBUTION PERMISSION FORM

  • (Only for students who will take medication during program or needs medicine, including an inhaler or Epi-pen, to be kept on-site.)

    I give the West Cook YMCA permission to administer the following medication to my child.

    • Medication must be in its original, labeled container. No medication will be accepted if not the original container.
    • The child’s name must be on the medication container.
    • The date on the prescription must be current (within 1 month for antibiotics; and within 1 year for other medications).
    • The medication’s name, dose and frequency of administration on the label must be consistent with parental instructions.
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    Pick a Date
  • Clear
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    Pick a Date
  • Student # 3 Information

  • STUDENT 3 APPROVAL FOR WEST COOK YMCA ACTIVITIES

    Please check all the appropriate boxes that you are approving or not approving and sign and date at the bottom of the page.
  • Clear
  •  -  -
    Pick a Date
  • STUDENT 3 HEALTH HISTORY FORM

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  •  -
  • If your child needs medication administered to him/her during program please complete the medical distribution permission form. Please list ANY additional information about your child’s health history, behavior, and physical, emotional, or mental health about which the YMCA staff should be aware. All information given is confidential and will only be viewed by necessary YMCA staff.

  • STUDENT 3 WEST COOK YMCA SCHOOL AGE DEVELOPMENTAL HISTORY

  • Developmental and Social Experience

  • Health History and Eating Habits

  • Browse Files
    Cancel of
  • STUDENT 3 MEDICAL DISTRIBUTION PERMISSION FORM

  • (Only for students who will take medication during program or needs medicine, including an inhaler or Epi-pen, to be kept on-site.)

    I give the West Cook YMCA permission to administer the following medication to my child.

    • Medication must be in its original, labeled container. No medication will be accepted if not the original container.
    • The child’s name must be on the medication container.
    • The date on the prescription must be current (within 1 month for antibiotics; and within 1 year for other medications).
    • The medication’s name, dose and frequency of administration on the label must be consistent with parental instructions.
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    Pick a Date
  • Clear
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    Pick a Date
  • Student # 4 Information

  • STUDENT 4 APPROVAL FOR WEST COOK YMCA ACTIVITIES

    Please check all the appropriate boxes that you are approving or not approving and sign and date at the bottom of the page.
  • Clear
  •  -  -
    Pick a Date
  • STUDENT 4 HEALTH HISTORY FORM

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  • If your child needs medication administered to him/her during program please complete the medical distribution permission form. Please list ANY additional information about your child’s health history, behavior, and physical, emotional, or mental health about which the YMCA staff should be aware. All information given is confidential and will only be viewed by necessary YMCA staff.

  • STUDENT 4 WEST COOK YMCA SCHOOL AGE DEVELOPMENTAL HISTORY

  • Developmental and Social Experience

  • Health History and Eating Habits

  • Browse Files
    Cancel of
  • STUDENT 4 MEDICAL DISTRIBUTION PERMISSION FORM

  • (Only for students who will take medication during program or needs medicine, including an inhaler or Epi-pen, to be kept on-site.)

    I give the West Cook YMCA permission to administer the following medication to my child.

    • Medication must be in its original, labeled container. No medication will be accepted if not the original container.
    • The child’s name must be on the medication container.
    • The date on the prescription must be current (within 1 month for antibiotics; and within 1 year for other medications).
    • The medication’s name, dose and frequency of administration on the label must be consistent with parental instructions.
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    Pick a Date
  • Clear
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    Pick a Date
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