YMCA of Southern Nevada - Summer Day Camp Assistance Application - (YCA)
Parent/Guardian Name #1
*
First Name
Last Name
Parent/Guardian Name #2
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child/s Name
*
Child/s Date of Birth
*
Please list the following for all people living in the household: Persons name, age and relationship to primary
*
Marital Status
*
Who currently has custody of the child(ren)?
*
Please Select
Joint
Mother
Father
Foster
Guardian
Please provide proof of child dependency
*
Please Select
Birth Certificate
Income Tax Return
Other
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*
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Current Employment Status Parent/Guardian 1# - All adults in the household must be currently employed or enrolled in school to qualify for YCA. Please select employment status and upload documents below
*
Current Employment Status Parent/Guardian 2#
*
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*
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Please indicate and upload all other sources of applicable income
*
Please upload all tax forms, income verification and other documentation required to apply. If possible, please block out personal information such as social security numbers and bank account numbers
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What location will your child be attending?
*
Please Select
Centennial Hills
SkyView - Preschool Only
Durango Hills
Heinrich
Which weeks of summer camp will your child(ren) attend?
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Week 1 - May 26 - May 29
Week 2 - June 1 - June 5
Week 3 - June 8 - June 12
Week 4 - June 15 - June 19
Week 5 - June 22 - June 26
Week 6 - June 29 - July 3
Week 7 - July 6 - July 10
Week 8 - July 13 - July 17
Week 9 - July 20 - July 24
Week 10 - July 27 - July 31
Week 11 - August 3 - August 7
Please provide any additional details below
Would you like your application to also be processed for YMCA membership assistance?
*
No
Yes
Submit
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