Intent to Enroll for the Lebanon YMCA SACC Program

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This form is for the fall of 2023-24 School Year. By completing this form, it does not guarantee you space into our program. You will receive an email from childcare@lebanonymca.org, confirming your spot in our program. Please take 2 minutes and complete the form below.

Email *

Parent First and Last Name *

Child's First Name *

Child's Last Name *

Street Address *

City, State and Zip *

Best Contact Number *

Child's Date of Birth *

YYYY

Gender *

Female

Male

Elementary School *

Grade in Fall of 2023-24 *

I would like care for *

Before

After

Both, Before and After

I plan to pay: *

Weekly

Monthly

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