2023 SUMMER DAZE

{ for Kids entering K - 5th Grade }

Thank you for considering the YMCA at ACRC for your Child Care needs this Summer! Our Summer Daze program strives to create a fun, caring and inclusive atmosphere for your child. Our goal is to allow kids the opportunity to facilitate connections with their peers, engage in interactive play, enjoy our facilities top amenities and safely explore our local community. Our friendly Y childcare team will make every effort to provide a safe and healthy environment for your family by following all necessary CDC and MDH guidance, including capacity restrictions that will unfortunately limit the number of families we can serve this summer.

It is important to note, filling out this form does NOT guarantee your child a spot in our program. Spots will be given on a first come, first serve basis. After completing this form, a Y team member will be in contact with you regarding availability.

Full Day (7:30am - 5:30pm) - $175/week per child

AM Half Day (7:00am - 12:00pm) - $75/week per child

PM Half Day (12:30pm - 5:30pm) $100/week per child

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 Child Care Department? *

Yes

No

Grade entering Fall 2023 *

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 *

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 *

CHILD CARE SERVICES

Please let us know which days of the week we can expect your child(ren).

June 12th - 16th *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed

June 19th - 23rd *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed

June 26th - 30th *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed

July 3rd - 7th *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed

July 10th - 14th *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed

July 17th - 21st *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed

July 24th - 28th *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed

July 31st - August 4th *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed

August 7th - 11th *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed

August 14th - 18th *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed

August 21st - 25th *

	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed
-	Full Day Weekly	AM Weekly	PM Weekly	No Care Needed