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YMCA Child Care Waitlist and Registration Application Form
YMCA
2022-07-22T10:30:43-02:30
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 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)
School Age - Juniper Ridge Intermediate
School Age - Macdonald Drive Elementary
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
Name of Person Completing Form
(Required)
First
Last
Date Completed
(Required)
Day
Month
Year
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