Child Care Interest Form 2017-2018 School Year, Public Registration
YMCA School Age Programs – University Y
(Sand Point Elementary)
CHILD’S INFORMATION
Legal First Name / MI / Legal Last Name
School Attending in the Fall / Grade in Fall 2017
MONTHLY CARE OPTIONS / FACILITY MEMBER RATE / COMMUNITY MEMBER RATE
□ After School Care EXTENDED
Cost includes After School Care and early release days
Does not include Non-Student Days and Breaks / $450/month / $515/month
□ After School Care EXTENDED PLUS
Cost includes After School Care, Early Release Days, Non-Student Days & Breaks / $500/month / $570/month
YMCA School Age Program Site:
Sand Point
Please note: Financial assistance may be available through State or City funding, as well as limited funds through the Y.
For City of Seattle subsidy call 206-386-1050 (see attached flyer) and for State DSHS subsidy visit www.washingtonconnection.org. If you don’t qualify for either you may be eligible for financial assistance through the Y and can find our financial assistance application online at www.ykids.org .
PARENT/ GUARDIAN CONTACT INFORMATION
Legal First Name / MI / Legal Last Name
Email / Phone Number
DISCLOSURE STATEMENT AND ACKNOWLEDGEMENT
Filling out this Child Care Interest Form does not guarantee your child a spot in this program. IF demand is higher than available spots, your child’s name will be entered into a random lottery for available spaces for the Fall of 2017.
Selected families will be required to complete a Child Care Registration Packet to officially register your child. Those not selected at this time will be put on a waitlist and contacted if and when space becomes available. All families will be notified by April 17th as to whether your child will have a spot in the program or has been waitlisted.
Please return this form to Brianna Hickey, Program Registrar at or in-person at the University YMCA ATTN: Brianna Hickey by May 15th, to be entered into the lottery.
Thank you for your interest in the Y! For info on our other great programs visit us ykids.org!