$30/child per day • 8:30am - 5:00pm

We are offering child care to Essential Tier 2 Emergency Workers and working to assess the need for non-essential Child Care. If you are in need of Tier 2 Child Care, please fill out this form, we will screen the information collected and prioritize the Care to our Essential Emergency Workers first. Please be mindful that if we have the need for more child care, we will do our best to accommodate. 
If your child has a severe allergy (nuts or otherwise) we are not able to accomodate you at this time.
Days needing care *
Will you need Financial Assistance? *

Child Information (Grades K - 6th)

Member of the YMCA at ACRC *
Child is currently a particpant in our After School/School-Aged Child Care Program? *
Additional Child *
Member of the YMCA at ACRC *
Child is currently a particpant in our After School/School-Aged Child Care Program? *
Additional Child *
Member of the YMCA at ACRC
Child is currently a particpant in our After School/School-Aged Child Care Program? *
Additional Child *
Member of the YMCA at ACRC
Child is currently a particpant in our After School/School-Aged Child Care Program? *

Parent/Guardian Information

I am an Tier 2 Emergency Worker as mandated by the Governor.  *

Emergency Contact Information

Medical Information

If the YMCA Staff will need to adminster any medication to your child(ren) while they are at the YMCA, please contact our Child Development Director, Melissa Hussey at mhussey@ymcaatacrc.org
Please use your finger or stylus to sign below verifying that all the above information is correct. 
 *
clear