Before & After School Interest Survey

Before & After School Interest Survey

PLEASE NOTE: Submission of this form does not register your child in the childcare program. YMCA staff will contact you to get more information, or with the registration link.
IF YOU HAVE ALREADY COMPLETED THIS FORM, PLEASE WAIT FOR AN EMAIL FROM THE YMCA TO COMPLETE REGISTRATION.
Parent Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Student Information

When would your child be attending?

AM OnlyPM OnlyBoth AM & PM
Does your child have any development or behavioral concerns?*

YesNo
If yes, please explain.
Does your child have an IEP?*

YesNo
If yes, please explain
Does your child have a paraprofessional during the school day?*

YesNo
If yes, please explain
*The YMCA welcomes participation by all children of all abilities. Every effort is made to provide reasonable accommodations, however, there may be instances where a child's needs may exceed the parameters of the scope of our program. All requests for accommodations will go through an approval process that takes at least 2 weeks.

*All children enrolled must be completely toilet trained due to insurance and legal requirements.
Reservation Request*

I understand that submission of this form does not guarantee space in the childcare program. YMCA staff will contact me with next steps to register.
Should be Empty:

IF YOU HAVE ALREADY COMPLETED THIS FORM, PLEASE WAIT FOR AN EMAIL FROM THE YMCA TO COMPLETE REGISTRATION.