Summer Camp, 2024/Afterschool 2024-2025 Pre-registration
We are excited to have you and your child join or continue to be a part of  our Y family!

Please fill out all requested information on this form as completely as possible.

We offer financial assistance so that all children have access to our programs. No child will be turned away for financial reasons.
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Child's Full Legal Name:
 *
Does your child use a first name different than their legal name? If so, please let us know so we can refer them using that name.
Child's Date of Birth: *
MM
/
DD
/
YYYY
Child's Preferred Pronouns: *
Required
Child's Address:
(Please include complete address with city, state, and zip code)
 *
Parent/Guardian Contact Info
Please provide all requested information. This information is very important since it will be used to contact you or your child's other parent/guardian in case of an emergency.

If your child has only 1 parent/guardian please type "NA" in the section for "Parent/Guardian #2 Info".
Please enter the primary email address we should use for correspondence about this child. The email address entered in this field will also be used for an auto confirmation when you submit the form: *
Secondary contact email address for correspondence about this child:
Parent/Guardian #1 Info

Full Legal Name
Email Address
Work Phone
Home Phone
Cell

Press return after each piece of information to keep things organized.
 *
Parent/Guardian #2 Info

Full Legal Name
Email Address
Work Phone
Home Phone
Cell

Press return after each piece of information to keep things organized.
 *
LOCAL Emergency Contacts/Pickups (Non Parent/Guardian)
Please list a MINIMUM of 3 adults, in addition to the parents/guardians listed above, who are authorized to pick up your child. Photo ID will be required for pick-ups.

Please only include local emergency contacts.

*We will be unable to complete registration unless completed correctly
Emergency Contact # 1 Name & Phone Number *
Emergency Contact # 2 Name & Phone Number *
Emergency Contact # 3 Name & Phone Number *
Emergency Contact # 4 Name & Phone Number
Emergency Contact # 5 Name & Phone Number
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