Family Update Form
To remove an account holder or emergency contact, change parental consents, you must complete a full application. Please contact your center director for the link.
Child's Name
*
First
Last
Date of Birth
*
MM slash DD slash YYYY
Childcare Program Location
*
Chose a Location
County YMCA
Downtown YMCA
Eastside YMCA
Glenwood Park YMCA
Camp Sherwin
The Y at Early Learning Center
The Y at Early Learning University
The Y @ Elk Valley Elementary School
The Y @ First Presbyterian Church- Waterford
The Y @ McKean Elementary School
The Y @ Northwestern Elementary School
The Y @ Summit United Methodist Church
The Y @ Wattsburg Elementary Center
Has any contact information changed for the Primary or Secondary Account holder ?
*
Yes
No
If yes, list below:
*
Have there been any changes to your Emergency contact or pick up persons?
*
Yes
No
If yes, list below:
*
Have there been any changes in the child’s Medical provider ?
*
Yes
No
If yes, list below:
*
Have there been any changes in the child’s insurance provider?
*
Yes
No
If yes, list below:
*
Have there been any changes in the child’s medications, allergies, dietary, diagnosis?
*
Yes
No
If yes, list below:
*
Additional Updates:
Please list any additional applicable updates to information below:
Today's Date
MM slash DD slash YYYY
I understand that I am updating information located on my child’s YMCA application and fee agreement
Signature
*