2022-2023 SCHOOL YEAR

{ Ages K - 4th Grade }

Thank you for considering the YMCA After School Program for your childcare needs!

We're so excited to kick off the school year and get to know our upcoming program participants. At the YMCA at Austin Community Recreation Center, our primary focus is to create a positive and inclusive atmosphere for students, while maintaining health and safety.

More information will be available soon; don't hesitate to contact Molly Kirtz at mkirtz@ymcaatacrc.org if you have any questions. We look forward to another great year!

After School programming will be provided Monday - Friday, from 2:00pm – 6:00pm, on regularly scheduled school days.

Afterschool Childcare Rates:

$35/week per child or $10/day per child

We will provide additional care in accordance with the Austin Public School District calendar -

Early Release Child Care:

$20/day, per child. Programming will run from 12pm - 6pm

No School Child Care:

$40/day, per child. Programming will run from 7am – 6pm

Fees:

$50/child, maximum charge of $100/family due upon registration. Registration fee is non-refundable.

$50/child supply/snack fee due Friday, August 19th

STUDENT INFORMATION

Student's First Name *

Student's Last Name *

Date of Birth * +

Gender *

Male

Female

Unspecified

Are this student's immunization records on file with our School Age Childcare department? *

Yes

No

Upload Immunization Records:

Would you like to upload an IEP (Individualized Education Plan) on behalf of this student? *

Yes

No

Not Applicable

Upload IEP

School attending *

Grade entering Fall 2022 *

Current Address *

Address 2

Zip/Postal Code *

Ethnicity of Student *

Do you have another Student to Register? *

Yes

No

Student's First Name *

Student's Last Name *

Date of Birth * +

Gender *

Male

Female

Unspecified

Are this student's immunization records on file with our School Age Childcare department? *

Yes

No

Upload Immunization Records

Would you like to upload an IEP (Individualized Education Plan) on behalf of this student? *

Yes

No

Not Applicable

Upload IEP

School attending *

Grade entering Fall 2022 *

Current Address Same as Previous Student *

Yes

No

Current Address *

Address 2

Zip/Postal Code *

Ethnicity of Student *

Do you have another Student to Register? *

Yes

No

Student's First Name *

Student's Last Name *

Date of Birth * +

Gender *

Male

Female

Unspecified

Are this student's immunization records on file with our School Age Childcare department? *

Yes

No

Upload Immunization Records

Would you like to upload an IEP (Individualized Education Plan) on behalf of this student? *

Yes

No

Not Applicable

Upload IEP

School attending *

Grade entering Fall 2022 *

Current Address Same as Previous Student *

Yes

No

Current Address *

Address 2

Zip/Postal Code *

Ethnicity of Student *

PARENT/GUARDIAN CONTACT INFORMATION

Parent/Guardian First Name *

Parent/Guardian Last Name *

Best Contact Number *

Email Address *

Marital Status *

Student(s) Live with this parent/guardian *

I would like to list an additional parent/guardian *

Yes

No

Parent/Guardian First Name *

Parent/Guardian Last Name *

Best Phone Number *

Email Address *

Marital Status *

Student(s) Live with this parent/guardian *

CHILD CARE SERVICES

Please select the option that fits your needs.

TYPE OF CARE *

Child Care ONLY - My child will NOT need transportation to the YMCA

Child Care AND Bussing - My child will need to be bussed from their school to the YMCA

AFTER SCHOOL CHILD CARE - $10/DAY OR $35/WEEK

Select 'All Days' each week for full time care at a rate of $35 weekly.

If your child will not attend full time, notate which days to expect them each week at a rate of $10/day.

*It is important that you notify us of any absences or deviations from the scheduled regsitration. We take attendance as children come off busses; this is how we account for each child's safety.

No refunds will be given unless we are notified 2 weeks in advance of the absence/change in schedule.*

After School Child Care *

	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
August 29 - September 2	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
September 6 - 9	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
September 12 - 16	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
September 19 - 23	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
September 26 - 30	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
October 3 - 7	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
October 10 - 14	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
October 17 - 21	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
October 24 - 28	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
October 31 - November 4	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
November 7 - 11	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
November 14 - 18	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
November 21 - 25	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
November 28 - December 2	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
December 5 - 9	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
December 12 - 16	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
December 19 - 23	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
January 2 - 6	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
January 9 - 13	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
January 16 - 20	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
January 23 - 27	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
January 30 - February 3	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
February 6 - 10	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
February 13 - 17	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
February 20 - 24	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
February 27 - March 3	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
March 6 - 10	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
March 13 - 17	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
March 20 - 24	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
March 27 - 31	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
April 10 - 14	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
April 17 - 21	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
April 24 - 28	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
May 1 - 5	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
May 8 - 12	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
May 15 - 19	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
May 22 - 26	All Days	No Care	Mon	Tues	Weds	Thurs	Fri
May 29 - June 1	All Days	No Care	Mon	Tues	Weds	Thurs	Fri

Please take note of the days you registered for; screenshots are encouraged!

NO SCHOOL CHILD CARE - $40/DAY, PER CHILD

Select No School Day(s) of care: *

EARLY RELEASE CHILD CARE - $20/DAY, PER CHILD

Select Early Release Day(s) of care: *

PAYMENT INFORMATION

$50 non-refundable fee required with submission. By inputing your financial information, you authorize the YMCA at ACRC to withdraw a one-time $50 charge. Registrations will not be accepted without payment. Financial assistance is NOT applicable to registration fees.

Payment Type *

EFT (checking/savings)

Credit / Debit Card

Name on Card *

Card Type *

Card Number *

Expiration Date (mm/yy) *

Billing Address *

Billing Address Line 2

Billing City *

Billing Zip Code *

Name on Account *

Bank Routing Number *

Bank Account Number *

SIGNATURE

Parent / Guardian Signature *

clear

No Care Needed	October 19	October 20	October 21
November 23	November 25	December 23	January 16
February 17	February 20	March 10	March 13
April 3	April 4	April 5	April 6
April 7	May 29

No Care Needed	October 5	November 9	December 14
February 8	March 1	May 10	June 1