Collaborative Interest Form

The Collaborative Interest Form

Please fill in the form below to notify us of your interest for The Collaborative: Ypsilanti YMCA Child Development Center! Upon completing the form, you will be sent an email with further instructions regarding registration. Please email dleight1@emich.edu with any questions.
Full Name *

Prefix First Name Last Name
Cell Number *

Area Code Phone Number
Would you like to opt-in to our Collaborative Text Alerts? You will receive an automated reminder when registration is open to have first access. Your information will be kept secure and private. *

Yes No
E-mail *
EID *
How many credits are you enrolled in for Fall and/or Winter semester? *
Are you interested to enroll your child(ren)? If so, we will contact you with further information. *

Yes No
Please enter the age(s) of your child(ren) in the box below. If you are interested in enrolling more than one child, please separate the ages with a comma (ex: 18 months, 2 years) *
Which term do you need childcare for? *

Fall Winter
We are piloting an evening care option this winter based on students' needs. Do you need evening (5pm-9:30pm) care? If so, what evenings would you need?
Are you interested in learning more and/or participating in the student organization, EMU Students with Children?

Yes No Possibly
Any further questions or comments?
Should be Empty:

The Collaborative Interest Form