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YMCA Child Care Waitlist and Registration Application Form
YMCA
2022-07-22T10:25:35-02:30
YMCA Child Care Waitlist and Registration Application Form
Child's Information
Child's Name
(Required)
First
Last
Child's Date of Birth
(Required)
Day
Month
Year
Child's Address
(Required)
Street Address
City
Postal Code
Does the child you are registering have a sibling(s) in another YMCA of NL regulated child care program?
(Required)
Yes
No
If yes, please indicate sibling(s) full name(s):
Parent/Guardian Information
Parent/Guardian # 1 Name
(Required)
First
Last
Parent/Guardian #1 Address
(Required)
Street Address
City
Postal Code
Preferred Phone #
(Required)
Alternate Phone #
Email
(Required)
Are you actively employed in the health care sector? If yes, ID or confirmation of employment will be required to move from the waitlist to registration.
(Required)
Yes
No
Are you actively employed with the YMCA of NL?
(Required)
Yes
No
Parent/Guardian #2 Name
First
Last
Parent/Guardian #2 Address
Street Address
City
Postal Code
Preferred Phone #
Alternate Phone #
Email
Program Information
Program
(Required)
Infant
Toddler
Full Day Preschool
Full Day Preschool - Health Care Workers
Preferred Start Date
(Required)
Day
Month
Year
Payer Information
Please indicate who will be paying child care fees:
Payer #1
(Required)
Payer #2
Payer #3
Auto Renewal
I wish to continue my child's enrollment from year to year in the program stated above.
Name of Person Completing Form
(Required)
First
Last
Date Completed
(Required)
Day
Month
Year
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