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  • Summer camp banner image with children

  • YLC Summer Registration

    Primary Care Hours: 7:30 a.m. to 6:30 p.m

  • Child's Information

  • Grade (2026-2027)*
  • Gender*
  • Is Child Proficient in English?*
  • Previously Registered*
  • Child's Primary Language:*
  • Do they attend a private school?*

  • FAMILY INFORMATION

  • Parent/Guardian Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • EMERGENCY CONTACTS AND AUTHORIZED PICK UP

    Note: In case of an emergency, at least one parent, guardian or designated emergency contact person needs to be available to respond to the site within 15 minutes. Responding party should be authorized to make an emergency medical decision on behalf of the child.

  • Emergency Information

     

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Person(s) Authorized to pick-up child from program (Other than Parent/Guardian)

    Your child will not be released to any person not listed herein.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • MEDICAL INFORMATION

    I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.

  • I,* , parent/legal guardian of* hereby disclose the following information/condition of my child.

  • Does your child have health insurance (ex., private insurance, KidCare, Medicaid)?*
  • Does your child have any allergies (ex., food, medicine)?*
  • Does your child use an EPI Pen?*
  • Does your child know how to use the EPI Pen?*
  • Does your child have a documented medical condition or a disability?*
  • If yes, how would you best classify the type(s)? (check all that apply): What conditions does your child have that are expected to last for a year or more? (Mark all that apply)*
  • If yes for any of the above, do you have (check all that apply):*
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  • Does your child have a therapist who will need to be present on-site?*
  • Do you authorize the City of Hialeah to transport the participant to and from program/events/field trips sponsored and/or approved by the Summer Program.*
  • We will be having pool days as part of our activities. Could you please let us know if you would like your child to participate?*
  • Does your child know how to swim? A life Jacket will be provided.*
  • Date
     - -

  • Please upload your documents below:

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  • Please note that submitting a registration form does not confirm your enrollment in the program. To complete your registration, payment must be made at our main office. Additionally, if any required documents are missing, your registration will be returned for completion.

  • Date
     - -

  • We're sorry, our program is only available to Miami-Dade County residents.

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