Early Education Inquiry Form — YMCA of Greater Toledo

6 weeks - 5 years

This is not a registration or enrollment form, but an inquiry about YMCA Early Childhood programs.

Child's Information

Child's Name *

First name

Last name

Child's Gender *

Female Male

Birth Date *

Please choose the appropriate child care site for your child.

Child's age group *

Infant (6 weeks to 18 months) Toddler (18 months to 3 years) Preschool (3 to 5 years)

Infants (6wks-18mths) *

Toddler (18mths-3yrs) *

Preschool (3yrs-5yrs) *

Parent/Guardian 1 Information

Parent/Guardian 1 Name *

First name

Last name

Email *

example@example.com

Phone Number *

Address *

Street address

Street address line 2

City

State

ZIP

Parent/Guardian 2 Information

Parent/Guardian 2 Name

First name

Last name

Email

example@example.com

Phone Number

Click to copy guardian 1 address to guardian 2 if the same

Yes

Address

Street address

Street address line 2

City

State

ZIP

Additional Information

Are you a YMCA member? *

Yes No

Please select which days you would need care. (Check all that apply) *

Monday Tuesday Wednesday Thursday Friday

My child's fee will be paid by: *

How did you hear about YMCA/JCC child care?

Special needs or requests

6 weeks - 5 yearsThis is not a registration or enrollment form, but an inquiry about YMCA Early Childhood programs.

Child's Information

Please choose the appropriate child care site for your child.

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Additional Information

6 weeks - 5 years

This is not a registration or enrollment form, but an inquiry about YMCA Early Childhood programs.