School-Age Care (October-December 2020) Please fill this form out for scheduling purposes. As always, we will do our best to meet your needs. A staff member will contact you to discuss any scheduling questions and to finalize your child’s schedule and location(s). Step 1 of 3 33% Child's Name* First Last Child's Date of Birth* Date Format: MM slash DD slash YYYY Parent's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* What school does your child attend?*Does your child need busing?* Yes No Is your child attended YWCA Young Wonders currently?* Yes No Do you want us to work with/exchange information with your child’s school/teachers for the health and development of your child?* Yes No SchedulePlease mark an attendance option for each day of the week.Monday* Before Care After Care Full-day eLearning None Tuesday* Before Care After Care Full-day eLearning None Wednesday* Before Care After Care Full-day eLearning None Thursday* Before Care After Care Full-day eLearning None Friday* Before Care After Care Full-day eLearning None If you chose full-day eLearning, what time will your child attend?* 6:30 a.m. - 3:30 p.m. 7:30 a.m.–4:30 p.m. 8:30 a.m.-5:30 p.m. My child will not attend full-day eLearning Will your child need assistance with eLearning and/or tutoring?* eLearning Tutoring Both Neither Please read the following statement and sign in the box indicating you have read and understand.*I understand that on eLearning days I am responsible to ensure my child’s electronics accompany them as well as any scheduling, or classroom needs are communicated to the teacher at YWCA. I further understand that YWCA Young Wonders requires two weeks for schedule changes and I will be billed according to this form.