Registration Request and Enrichment Interest Form
Hello!

Please complete the form below if you are interested in participating in the 22-23 YMCA Programs! We are currently taking registration request for the before care program and hoping to learn more about after school enrichment interest! If you are interested in before care, we will contact you for registration. Once we learn more about enrichment programs, we will send out a flyer with our options!

If you have any further questions please email our program team at ymcabeforeandafterschool@ymcachicago.org

Please fill out 1 form per child.
Sign in to Google to save your progress. Learn more
Email *
Child's Full Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Grade for the Upcoming School Year *
Child's Address
Parent's Full Name *
Parent's Phone Number *
Are you in need of before care services beginning at 7:00am?
Clear selection
Are you interested in setting up auto payments?
Clear selection
Are you interested in learning more about financial aid?
Clear selection
Are you interested in session based enrichment activities located at the school? *
What type of enrichment activity would your child be interested in? *
Is there anything else you would like to share with the YMCA? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of YMCA of Metropolitan Chicago. Report Abuse