KIDS CLUB APPLICATION
Please complete one form per child
If Middle School student, looking for Wednesday only, complete form and click Middle School for grade, and Wednesday as day.
Child's First Name
Child's Last Name
Middle School (Wednesday only)
Home Phone #
Second Phone #
List of people who can pick up child
Days of weeks you will be attending
Would you attend our full day Wednesday program ?
Medical Issues our Staff need to know
Waiver and Permission
I do hereby grant permission for my Son / Daughter / Legal Dependent to participate in the Winthrop Area YMCA Kids Club, I agree to adhere to the policies set forth in the Program Information document. I agree to pay the agreed upon fees on schedule. I agree to the Code of Conduct and support any decisions made by staff I agree to give permission for photographs to be taken of my child, to be used in program publicity and website.
A copy of your responses will be emailed to the address you provided.
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