JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
After School 2020-2021 Registration Form
The YMCA After School Program Registration
$25.00 Registration Fee
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Please pick one of the registration options
*
$35.00 per week for YMCA Members
$70.00 per week for Non-Members
Child's (FULL) Name:
*
Your answer
Sex
*
Male
Female
Grade
*
P-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
Date of Birth
*
MM
/
DD
/
YYYY
Best Contact Number
*
Your answer
School Attending
*
Milan Elementary School
Milan Middle School
Home Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Mother's Name
*
Your answer
Mother's Cell Phone Number
*
Your answer
Father's Name
*
Your answer
Father's Cell Phone Number
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Please list any medical needs and/or allergies your child may have which we should know about
*
Your answer
Transportation: The following individuals have permission to transport my child. Please list their name(s) with a contact number below:
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Milan Special School District.
Report Abuse
Forms
