Child Care Inquiry

This is not a registration or enrollment form, but an inquiry about YMCA Child Care.

Please select a Child Care program.
Child's Information 
Child's First Name
Child's Last Name
Child's Gender
Child's Birthdate
Parent's Information
Parent/Guardian First Name
Parent/Guardian Last Name
Phone
Email
Address
City
State
Zip
Are you a Y member?
(SCHOOL- AGE ONLY) Please check the type of care your School-Age child will need.
(SCHOOL-AGE ONLY) Please select which days you would need care.
 Monday
 Tuesday
 Wednesday
 Thursday
 Friday
My child's fee will be paid by:
Special needs or request.

You will be contacted by a child care representative within 12 hours of submission. If you need additional assistance, please call 517.417.6105.

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