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  • Current Child's Information
  • Authorized Adults for Pick-Up
  • Questions/Comments
  • Waiver Form
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Child's Information

Please fill out this form for each of your children registered for any of the following programs at the Y:

  • Before School Care
  • After School Care
  • School's Out Club (full day care at the Y)


This information will be provided to the Y staff who are supervising your child at the school or at the Y.


Child's Information
Child's Address
This child is registered for:
Promotional Agreement
The Two Rivers YMCA and its funding partners have my permission to use photographs or videos of my child in YMCA promotional materials.
Internet Usage
I give permission for my child to use the internet under the supervision of the Y staff.
Floatation Device
My child needs a flotation device when swimming at the Y.
Sunscreen Application
I give permission to Y staff to help apply sunscreen on my child. I understand they will not apply sunscreen to any part of the body a swimsuit covers.
Please list any special needs (health, physical, dietary, educational, behavioral, etc)
Please list any allergies.
Please list all current prescription medications.
Please describe any specific activited to be encouraged or limited by physician's advice.