Before & After School Care Registration Before and After School Registration 2022-2023 Young Wonders Youth Development Before and After School 2022-23 For all additional questions and support, please call: 309-662-7826 or email: childcarecustomerservice@ywcamclean.org Child's InformationChild's Name First Last Child's Date of Birth MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country School Attending:BentCarlockColene HooseFox CreekIrvingOaklandSheridanStevensonWashingtonAdditional offsite locations to be determined based on enrollment.BussingDoes your child need bussing? Yes No Where should the bus take/pick up your child:BentCarlockColene HooseFox CreekIrvingOaklandSheridanStevensonWashingtonAdditional offsite locations to be determined based on enrollment.Does the child need to be dropped off at school? If so, what time does school start? *Bent provides district transportation to Hershey Rd. There is an additional $15 per week transportation fee. All bus routes are subject to change.Does the child need to be picked up from school? If so, what time does school end? *Bent provides district transportation to Hershey Rd. There is an additional $15 per week transportation fee. All bus routes are subject to change.What type of care do you need?We provide care between the hours of 6am and 6pm, Monday through Friday at YWCA. Off-site location hours are 6:30AM to 5:30PM.What type of care do you need? Before School Care After School Care Before AND After School Care Before School Care: Monday Tuesday Wednesday Thursday Friday Before school only. Select all days which apply.After School Care: Monday Tuesday Wednesday Thursday Friday After school only. Select all days which apply.Before AND After School Care: Monday Tuesday Wednesday Thursday Friday Select all days which apply.Has your child attended YWCA Young Wonders in the last year? Yes No Parent/Guardian InformationParent/Guardian 1 Name: First Last PhoneEmail Parent/Guardian 2 Name (if applicable): First Last PhoneEmail Product Name Price: Total
