What program is this registration for?* (Select One) Part Time Full Time
Which Site will your child attend?* (Select One)
The parent/guardian has received an electronic or paper copy of the parent handbook.
Objection To Medical Attention:
**If new, MUST have forms**Please Check boxes once forms are uploaded OR if forms has been previously submitted
Proof of the child’s identity and age may include a certified copy of the child’s birth certificate, birth registration card, notification of birth (hospital, physician, or midwife record), passport, copy of the placement agreement or other proof of the child’s identity from a child placing agency, record from a public school in Virginia, or certification by a principal or his designee of a public school in the U. S., that a certified copy of the child’s birth record was previously presented. Viewing the child’s proof of identity is not necessary when the child attends a public school in Virginia and the center assumes responsibility for the child directly from the school (i. e. after school program) or the center transfers responsibility of the child directly to the school (i. e. before school program). While programs are not required to keep the proof of the child’s identity, documentation of viewing this information must be maintained for each child.
Altavista YMCA Tomahawk Elem. Rustburg Elem. Gretna Elem.
Lessville Rd Elem. Yellow Branch Elem. Concord Elem.
ALL SCHOOL YEAR ACCOUNTS MUST HAVE A ZERO BLANCE BEFORE STARTING THE SUMMER PROGRAM
ALL INFORMATION MUST BE FILLED OUT COMPLETELY. ANY INCOMPLETE CONTRACTS WILL BE RETURED AND A SPACE WILL NOT BE HELD FOR YOUR CHILD UNTIL CONTRACT IS COMPLETED AND RETURNED.
POST OFFICE BOXES ARE NOT ACCEPTABLE ON THIS CONTRACT. ALL INFORMATION HAS TO BE COMPLETED. THE HOME & WORK ADDRESS MUST BE COMPLETELY FILLED OUT WITH THEIR PHYSICAL 911 ADDRESS.
I/WE hereby agree to the terms of this contract.
DO NOT SIGN CONTRACT FOR SPOUSE.