D90 26/27 Kindergarten After-School Signature Program Enrollment Form

2026-2027 School Year: YMCA Kindergarten After-School Program Enrollment Form for D90 Families
The first step in the enrollment process for the Kindergarten Afterschool 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 2 children residing in the same household. Additional forms that will be required include your child(ren)'s health exam form so please prepare to have it on hand so that when our staff reach out to complete the process you will be able to upload with your registration packet.

The YMCA follows the School District 90 Calendar, and for days those students are in school, the afterschool program will be operating, including half days or early release days. The program will not be operating on days that school is closed, including inclement weather days in which the school closes. The program will run Monday- Friday from the end of the school day until 5:30 pm.

KINDERGARTEN AFTERSCHOOL PROGRAM TUITION

School Year Afterschool Program tuition is $5,400. The tuition is split up in 9 even payments of $600. First payment is due by August 15th. Remaining payments will be scheduled on a monthly basis starting October 1st through May 1st.

Continued this school year is a modified schedule options and updated fees:

4-5 days | Monday through Friday | Tuition for school year is 9 payments of $600.

3 Days | Mondays, Wednesdays, and Fridays only | Tuition for school year is 9 payments of $420.

2 Days | Tuesdays and Thursdays only | Tuition for school year is 9 payments of $320

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 Name

First NameLast Name
Parent/Guardian 1 Date of Birth

MonthDayYear
Date
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 Place of Work
Parent/Guardian 1 Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Email Address
example@example.com
Parent/Guardian 1 Preferred Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Alternate Phone
Please enter a valid phone number.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 Name

First NameLast Name
Parent/Guardian 2 Date of Birth

MonthDayYear
Same residence as Parent/Guardian 1
Parent/Guardian 2 Place of Work
Parent/Guardian 2 Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Email Address
example@example.com
Parent/Guardian 2 Preferred Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Child(ren) resides with Parent/Guardian 2

Family Information
Family Dynamics (please share situations that may have an impact on your child(ren) so we can best support them while they are in the after-school signature program.):
When necessary, who should be contacted first?

Other

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.
If you do not give consent for emergency medical treatment as listed in previous question, please list what you do give the YMCA staff the authority to do:
I approve as checked above and know the responsibility would rely on me for any medical costs that would come up. I give authorization based on the choices made above.
Date of Signature

MonthDayYear
Date

Health History Form
Family Physician's Name

PrefixFirst NameLast Name
Physician's Phone
Please enter a valid phone number.Format: (000) 000-0000.
Physician's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Family's Dentist's Name

First NameLast Name
Dentist Phone
Please enter a valid phone number.Format: (000) 000-0000.
Dentist Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Serious illnesses and/or hospitalizations. If more than one child, please label by child's name.
Special physical conditions or disabilities that may require accommodations (please be specific) If more than one child, please list by child
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 d90asp@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
Emergency Contact 1 Name

First NameLast Name
Relationship to child

Other
Emergency Contact 1 Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Would you like to add another emergency contact?

Emergency Contact 2 Name

First NameLast Name
Relationship to child

Other
Emergency Contact 2 Cell Phone
Please enter a valid phone number.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 d90asp@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.
Additional Pick Up 1 Name

First NameLast Name
Additional Pick Up 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Conditions for releasing child (if any)
Would you like to add an additional pick-up person?

Additional Pick Up 2 Name

First NameLast Name
Additional Pick Up 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Conditions for releasing child (if any)
Would you like to add an additional pick up person?

Additional Pick Up 3 Name

First NameLast Name
Additional Pick Up 3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Conditions for releasing child (if any)

Please submit your 2026-2027 YMCA Kindergarten After-School Signature Program 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 d90asp@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 and tuition payment by August 17th.

Please email, fax, or drop off a copy of your child’s most recent copy of a physical. This will need to be submitted by September 5th.

Thank you.
Please complete the following checklist to ensure your registration is completed prior to submission:
Should be Empty:

2026-2027 School Year: YMCA Kindergarten After-School Program Enrollment Form for D90 Families

PARENT/GUARDIAN INFORMATION

PARENT/GUARDIAN INFORMATION (Cont.)

Child 1 Information

Child 2 Information

Family Information

Approval for West Cook YMCA Activities

Health History Form

Emergency Contacts

Additional Authorized Pick-Up