6:30 A.M. Start of School

ClintonCommunityYMCA

YZone

Kindergarten- 5th grade

Monday – Friday

6:30 a.m. – Start of School

End of School – 6:00pm

REGISTRATION PROCESS: Only Y-Zone Kids who are registered and paid may attend Y-Zone. All payments (including parent’s co-pay)must be made bythe Saturday prior to attending Yzone. There will be a $5/per day late fee per child if the child attends and payment is not made that day. Refunds and credits will not be issued for days missed. Register at the Courtesy Desk with this form and receive a parent’s manual for more information. No child is turned away! We have an open door policy and a financial package for EVERYONE! First day of attendance is August 17th. The two sites will be Lincoln Elementary and CES Elementary. Transportation will be provided for Douglas Elementary students to and from Lincoln Elementary.

------Registration Form ------(one form per child) ------

Complete and return to Clinton Community YMCA, 417 S. Alexander St., Clinton, IL61727. $20.00 (nonrefundable) registration fee (does not include T-Shirt price) must accompany this form. Y-Zone Schedule to start on August 17th

Child’s Name ______Grade in 2016-2017 ______

Please Print Clearly- First (what your child goes by) and Last Name

Parent/Guardian ______Child’s Date of Birth ______

Address ______City ______State ______Zip ______

Day Phone ______Other (Cell) Phone ______

I hereby give permission for my child to enroll in the Clinton Community YMCA Y-Zone. I agree to complete the parent packet information, pick-up authorization card, waiver, and Health Form before my child’s first day of attendance.

Parent/Guardian Signature ______

Informed Consent Agreement

I hereby certify that my child is of normal health. I assume all risks related to the conduct of the program. I will hold harmless the Clinton Community YMCA and its staff from any claims, suits or losses including but not limited to claims resulting from injury or death, accidental or otherwise. I authorize the Clinton Community YMCA and staff to obtain medical treatment for my child in the event I cannot be contacted.

Office Use Only

First day child______$20.00 Reg. fee____Y / N__ Amt. paid______Date______

attending campFirst week___ Y / N___ Amt. paid______

T-shirt____Y / N__ Amt. paid______Staff Initials

Total amt. paid ______