D89 Esports Enrichment Form
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  • 2023-2024 School Year: YMCA Esports Enrichment Program Enrollment Form for D89 Middle School Families

  • The first step in the enrollment process for the YMCA Esports Enrichment Program is to complete the following enrollment form. Once you have completed the entire form an email will be sent confirming we have received your completed enrollment form. A West Cook YMCA team member will follow up to confirm the next steps. You can register up to 4 children residing in the same household. 

     

    The YMCA follows the School District 89 Calendar. The program will not be operating on days that school is closed, including inclement weather days in which the school closes. 

  • PARENT/GUARDIAN INFORMATION

    Parent/Guardians listed on this page are allowed to pick up on a regular basis and under any condition.
  • Parent/Guardian 1 Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Child(ren) resides with Parent/Guardian 1*
  • Would you like to add another parent/guardian? Please note: If a second parent or guardian will be picking up your child(ren), please add them here.*

  • PARENT/GUARDIAN INFORMATION (Cont.)

    Parent/Guardians listed on this page are allowed to pick up on a regular basis and under any condition.
  • Parent/Guardian 2 Date of Birth*
     - -
  • Same residence as Parent/Guardian 1*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Child(ren) resides with Parent/Guardian 2*

  • Child 1 Information

  • Child 1 Date of Birth*
     - -
  • Child 1 Gender*
  • Child 1 Race*
  • Child 1 Ethnicity*
  • Child 1 Grade for 2023/2024 School Year*
  • Child 1 T-shirt Size*
  • Would you like to add another child?*

  • Child 2 Information

  • Child 2 Birthdate*
     - -
  • Child 2 Gender*
  • Child 2 Race*
  • Child 2 Ethnicity*
  • Child 2 Grade for 2023/2024 School Year*
  • Child 2 T-shirt Size*
  • Would you like to add another child?*

  • Child 3 Information

  • Child 3 Birthdate*
     - -
  • Child 3 Gender*
  • Child 3 Race*
  • Child 3 Ethnicity*
  • Child 3 Grade for 2023/2024 School Year*
  • Child 3 T-shirt Size*
  • Would you like to add another child?*

  • Child 4 Information

  • Child 4 Date of Birth*
     - -
  • Child 4 Gender*
  • Child 4 Race*
  • Child 4 Ethnicity*
  • Child 4 Grade for 2023/2024 School Year*
  • Child 4 T-shirt Size*

  • Family Information

  • When necessary, who should be contacted first?*

  • Approval for West Cook YMCA Activities

    Please check all the appropriate choices that you are approving or not approving.
  • Photo/Video Permission*
  • Emergency Medical Authorization: The purpose of this authorization is to enable parents and guardians to authorize provision of emergency treatment for children who become ill or injured while under our supervision when parents or guardians cannot be reached.
  • Date of Signature*
     - -

  • Health History Form

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Does your child need medication dispersed during program?*

  • Emergency Contacts

    Emergency contacts will only be contacted in the case of a situation where we need to get a hold of parents/guardians and we have not been able to. Emergency contacts will also be allowed to pick up children from the program. If anyone other than those listed will be picking up your child, you must contact Youth Development Program Staff via d89asp@westcookymca.org. Phone authorization will not be sufficient. For the safety of your child, anyone picking up your child must have a picture ID. Anyone without proper authorization will not be allowed to take your child
  • Relationship to child*
  • Format: (000) 000-0000.
  • Would you like to add another emergency contact?*
  • Relationship to child*
  • Format: (000) 000-0000.
  • Do you wish to authorize additional individuals to pick up your child?*

  • Additional Authorized Pick-Up

    All individuals who wish to pick up your child must be listed below, excluding parents and guardians listed under general information. If anyone other than those listed will be picking up your child, you must contact Youth Development Program Staff via d89asp@westcookymca.org. Phone authorization will not be sufficient. For the safety of your child, anyone picking up your child must have a picture ID. Anyone without proper authorization will not be allowed to take your child.
  • Format: (000) 000-0000.
  • Would you like to add an additional pick-up person?*
  • Format: (000) 000-0000.
  • Would you like to add an additional pick up person?*
  • Format: (000) 000-0000.

  • Please submit your 2023-2024 YMCA Esports Enrichment Enrollment Form using the submit button below. If we have any questions as we process the enrollment information, we will reach out to you. If you have any questions, please do not hesitate to email us at d89asp@westcookymca.org. We will be responding to inquiries on Tuesdays and Thursdays.

     

    Enrollment confirmations will be sent every 4 weeks leading up to final registrations by August 15th.

     

    Thank you.

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