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    RAINIER VIEW ELEMENTARY SCHOOL

    SCHOOL AGE CHILD CARE RESERVATION FORM 2018 - 2019 SCHOOL YEAR CENTRAL REGION YMCAS, SERVING SEATTLE PUBLIC SCHOOL LOCATIONS

     

    CHILDS  INFORMATION

    Legal First Name

    MI

    Legal Last Name

    School Attending in the Fall

    Date of Birth

    Grade  in Fall

    Gender

     

    MONTHLY CARE OPTIONS

    5 DAYS

    MONDAY  - FRIDAY

    3 DAYS

    MONDAY, WEDNESDAY & FRIDAY

    2 DAYS

    Tuesday & Thursday

    o

    After School Care Extended

    ·    Includes After School Care and Early Release Days until 6:00pm

    ·    Does not include Non-Student Days or Breaks

     

    $460  per month

     

    $330  per month

     

    $240  per month

    o

    After School Care Extended PLUS

    ·    Includes After School Care, Early Release Days, Non-Student Days and Breaks until 6:00pm

     

    $510  per month

     

    $365  per month

     

    $265  per month

    YMCA Youth Membership

    Each student enrolled in the YMCA School Age Child Care  Program  at Rainier View Elementary will be  provided with a free   YMCA Youth Membership, which offers discounts for YMCA programs such as youth sports, swim lessons and summer camp. Families may also apply the value of the Youth Membership toward a Family Membership.

    Financial Assistance

    YMCA Child Care is affordable for all. We accept State and City subsidy. To determine if you qualify for State DSHS subsidy, visit www.washingtonconnection.org. To determine if you quality for City Subsidy, call 206 386 1050 or email

    ccap@seattle.gov. In addition, the Y provides financial assistance and a sliding fee schedule to ensure all families have

    access to quality and enriching programs beyond the bell.

    PARENT/GUARDIAN  CONTACT  INFORMATION

    Legal First Name

    MI

    Legal Last Name

    Date of Birth

    Gender

    Email

    Phone Number

    ADDITIONAL QUESTION

    Do you have any health concerns, allergies, dietary restrictions or behavior concerns we should be aware of?

    DISCLOSURE STATEMENT AND ACKNOWLEDGMENT

    The Y Charges an annual registration fee of $50. This will hold your spot for the 2018/2019 school year program. Our Registrar will contact you for billing information to complete your enrollment. If the fee presents a challenge, please let our staff know so we can work on a payment arrangement with you. Families will be required to complete a Child Care Registration Packet to officially register their child.

    Cancellation Policy: Must provide two weeks written notice. If payment is already made, we will issue a partial refund. If payment is not made yet, we will adjust your upcoming payment based on when the two weeks notice is given.

    PARENT/GUARDIAN  SIGNATURE

     

     

    DATE