YMCA of Western North Carolina Corpening Memorial Center AFTERSCHOOL 2012-2013 REGISTRATION CHECKLIST

The following information must be received before a child is able to start the program. Please note that many programs fill quickly, and early registration is recommended. There is a one week waiting period from the date the completed application is received until the date the child is able to start the program. Incomplete forms can delay a childs start date.
Forms Youth Information Form You are required to complete a new Youth Information Form annually. Please note that we cannot use the form from the previous school year. We CAN use your 2012 Summer Day Camp form for the upcoming school year per your request when you register for Afterschool. Child Care Emergency Form Discipline and Behavior Management Policy Afterschool Policy Signature Form Field Trip Permission Form

Bank Draft Authorization Form Payments are by bank draft only. Draft dates and information is listed below. Individualized Care Plan Needed only If your child will be taking a medication while at Afterschool programs Current Copy of Immunization Record We can use the immunization record on file if the information is the same and there are no updates. Current Photo of Child (please place on the Youth Information Form in the spot labeled photo.) *Child Care Subsidy Vouchers Attached (optional) *YMCA Financial Assistance Application Attached (optional) Registration Fee and Payment The Registration Fee is Due at Time of Registration and must be paid separately from bank draft.

Registration Fee: $35 per child Weekly Payment: $45 Members

or

$50 per family

$55 Non-Members

Payment Method: Bank Draft Only. Drafted on the 1st and 15th of each month at $90 per child for Members and $110 per child for Non-Members. Please attach voided check or copy of credit card to be used. Total Payment Amount Enclosed $ ______________