Child Development Pre-Registration Summer 2023/After-School 2023-2024
This form is for children who have NOT participated in Y After-School programs or summer camp programs in the last year.

If your child is currently participating in Y After-School/Camp programs, please click here to verify/provide updates for medical, parental and emergency contact information for the coming summer/school year. 

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

Click for details about Y Camp 2023 & End of Summer Camp 2023. 

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Availability Update (3/20/24):
Aspen - Wednesday - 1 spot left
Barranca - Wednesday Only is full, 4x/week - 1 spot left, 5x/week is full
Chamisa - Wednesday - 2 spots left
Mountain - Wednesday Only is full, 4x/week is full, 5x week - 1 spot left
Pinon - Wednesday Only is full
Child's Full Legal Name:
*
Does your child use a name different than their legal name? If so, please let us know so we can refer them using that name.
Child's Preferred Pronouns: *
Required
What school does your child attend?
(Note: Homeschooled children and children who attend schools outside of LAPS are not eligible for the school year after school programs at LAPS school sites).
*
My child will be participating in:
(please select all that apply)
*
Required
If you are registering your child for After-School 2023-2024, please indicate below what schedule they will be on.

Please check the list above for current availability - note that this changes quickly.
*
If you are registering your child for After-School 2023-2024, please indicate which days they will attend. Check all that apply.

(Note: the total number of days indicated in the question should match the schedule requested above.)

*
Required
What grade will your child be in for the 2023-2024 school year? *
Child's age:
*
Child's Date of Birth: *
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Child's Address:
(Please include complete address with city and state)
*
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
Place of work
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
Place of Work
Work Phone
Home Phone
Cell

Press return after each piece of information to keep things organized.
*
I understand that I must provide documentation of legal status to the YMCA if custody of my child is in dispute.
*
Does your child have any known allergies?
*
If you answered "yes" to the above question please list know allergies:
Does your child have any medical/mental/physical condition(s)?
*
If you answered "yes" to the above question please list know medical/mental/physical condition(s):
Does your child currently take medication?
*
If you answered "yes" to the above question please list the medications:
Does your child participate in a special education program?
*
If you answered "yes" to the above question, please list the special educations programs your child participates in:
If your child participates in special education programs, do they use a one-on-one aide during the school day?
Clear selection
If your child is attending Y Camp, what is your child's swimming ability level?
(Sometimes our summer childcare programs will take field trips to local swimming pools. This information will help us in planning for that.)
Clear selection
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.
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
LIABILITY WAIVER, EMERGENCY MEDICAL AUTHORIZATION, MEDICAL TRANSPORTATION, FIELD TRIP, PHOTOGRAPH
PERMISSION AND DISCIPLINE POLICIES
On behalf of this minor child, enrolled in The Family YMCA Child Development Program, I hereby release the Y, staff and volunteers from all liability relative to participation in the program. I hereby give my permission to the Y staff to obtain emergency medical care and transportation for my child should the need arise. I understand that I am responsible for any expense incurred for such care. I understand that activities will periodically take place away from the usual program site. I give permission for my child to participate in field trips and off-site activities. I understand that The Y’s Child Development programs are considered a public venue therefore my child’s photograph could possibly be taken and may be used by the media, for internal publicity, and on the Y’s website which will not have the child’s name included. I have received a copy of the current parent handbook or acknowledge that it is online and I understand I am responsible for knowing all policies stated in the handbook, I accept such, including the discipline policies.
By typing my full legal name in the box I am acknowledging that I have read and understand the above statements. 
*
Date of acknowledgement:
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