Malone Central School District
When children enter the Y's Time program, a whole other world of imagination and growth opens up to them.  In addition to supplementing what they have learned in school, they participate in interactive learning models that engage critical thinking skills, have a chance to socialize with each other, and form long-lasting friendships that enhance their development, growth and self-confidence.

Our curriculum is based on a program model that focuses on learning enhancement, health and recreation, and building competence and confidence in children.  The program runs every regular school day until 5:30 PM, in a supervised and structured environment, providing a safe after school alternative for children.

Our Malone Program will take place at a school soon to be determined.

The monthly tuition is as follows:
$255.00 - PM Care (YMCA Members)
$275.00- PM Care (Community Members)
*Tuition is based on 180 days of school divided by 10 months, includes half-days.
**Financial Assistance is available.

If you have any questions regarding the program, or have interest in financial assistance, please email our Interim Co-Director, Brenna Hudson (bhudson@maloneymca.org).

Please complete the registration below for the 2023-2024 Academic School Year

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Email *
Student's Name:
School and Grade

Please enter school and grade your child is attending in September 2023
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Davis Elementary
Flanders Elementary
St. Joe's Elementary
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Which type of care will you be needing? *
Age as of September 1, 2023 (child cannot attend program if 13 or turning 13 during school year):
Date of Birth:
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Street Address, City, State & Zip
Name of Person Enrolling Child:

First & Last Name
Relationship to Child:
Phone Number of Person Enrolling Child:
Address of Person Enrolling Child (if different than child):
Child Lives With:
Parent/Caregiver #1 Employer and Normal Work Hours
Parent/Caregiver #2 Employer and Normal Work Hours
Emergency Contact #1 Name & Address:
Phone number(s) and email:
Authorized to Pick-Up Child?
Emergency Contact #2 Name & Address:
Phone number(s) and email:
Authorized to Pick-Up Child?
Emergency Contact #3 Name & Address:
Phone number(s) and email:
Authorized to Pick-Up Child?
Does child have any special needs/services?
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Does your Child have any allergies? (Please list)
Child's Primary Care Physician's Name/Group and Phone:
Child's Dental Care and Phone Number:
Is there anything else you would like us to know about your child?
I consent to emergency treatment for my child: *
I consent for my child to take part in neighborhood trips (i.e. library, park and playground) away from the program under proper supervision.
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I understand the program may need additional permissions for situations such as transportation, medication, release of information and field trips. *
I provided information on my child's special needs to the program to assist in caring for my child. *
I understand the program must give parents, at the time of enrollment of a child, a written policy statement as required by regulation.  I agree to review and update this information whenever a change occurs and at least once a year. *
I give permission for Y's Time Staff to apply over-the-counter topical ointments, lotions and creams, sprays (including sunscreen and insect repellent products) if needed. *
Photo Release

I agree that my consent and this release are irrevocable.  I hereby release and discharge YMCA of the USA and collaborating third parties from any and all claims in connection with the uses and reproductions, any video film, footage, sound track recordings and photo reproductions of me and/or my narrative account of my experiences as described.
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Signature (type name) *
Date: *
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Payment Information
All information provided below is safe, secured and used solely for the purpose of the Malone YMCA.
Payment Type
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Name on Card
Billing Street Address
Billing Zip Code
Card Number
Expiration Date
Financial Assistance is available to those who qualify!

Would you like to know more?
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Payment Authorization

I authorize my bank to honor payments to be drawn by the Malone YMCA from my account for payments related to the Y's Time Program.  When the bank honors the payments by charging my account, such transfer shall constitute notice of payment due and my receipt for payment.  Should any pre-authorization payment not be honored by the bank, I understand that it is my responsibility to pay the amount agreed upon, plus a service charge.  It is further understood that if such payment is not honored by the bank or credit card institution, the YMCA, at its discretion, may resubmit the amount dur for the payment on a future date.
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Signature

By entering your full name in the box below, you are providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.
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Date: *
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