YMCA of Greater Erie

Nice to meet you! (3 of 3)

Below is the final digital form to apply for childcare at the Y. Be sure to scroll all the way to the bottom and answer all required questions. There is also a save and continue option, at the bottom if you’d like to save your progress.

Child's Name*
First Last
Parent Email*
Childcare Location*
This field is hidden when viewing the form
Summer Camp
- Yes
Does your child have any siblings (names and ages)?*
Does your family have any pets?*
Does your child respond to any nicknames? Does your child have any nicknames for family members?*
Is there any other information about your family’s composition that you would like to share?
Has your child been in an early learning or school-age enrichment program before?*
- Yes
- No
How did your child react to other children and adults?
What do you think will happen the first day of your child’s attendance?*
Are there any special problems or fears that we should know about?*
Any special needs (medical, developmental, social, mental health)?*
Do any of these special needs require special care by our teachers?
Does your child have an IEP (Individualized Education Plan) or ISFP (Individualized Family Service Plan)?
- Yes
- No
If yes, we would like a copy of the plan so we can provide the best possible learning experience for your child. Please bring one on your first day.
What program or individuals work with your children in regards to these special needs? Would you sign a release of information with them so they can speak with us about how to provide enhanced support to your child?
Describe your child's schedule:
Normal bedtime, waking time, nap time and duration*
Meal times*
Does your child have a different schedule at any other settings (babysitter, relative/neighbor care, school)?*
Regarding toilet habits, what words does your family use for bowel movements and urination?*
Any special terminology for private parts?*
Is your child toilet trained?*
Does your child need to be reminded to go to the toilet during waking hours?*
Is there information that will help us make the first few days in our program easier for your child?
Is there other information you would like to share?