Before and After School Registration Form Before and After School Registration 2021-2022 Young Wonders Youth Development Before and After School 2021-22 A $50.00 non-refundable, non-transferable, registration fee is due at this time. For all additional questions and support, please call: 309-662-7826 or email: childcarecustomerservice@ywcamclean.org Child's InformationChild's Name First Last Child's Date of Birth MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country School Attending:BentCarlockColene HooseFox CreekIrvingOaklandSheridanStevensonWashingtonAdditional offsite locations to be determined based on enrollment.BussingDoes your child need bussing? Yes No Does the child need to be dropped off at school? If so, what time does school start? *Bent provides district transportation to Hershey Rd. There is an additional $10 per week transportation free. All bus routes are subject to change.Does the child need to be picked up from school? If so, what time does school end? *Bent provides district transportation to Hershey Rd. There is an additional $10 per week transportation free. All bus routes are subject to change.What type of care do you need?We provide care between the hours of 6am and 6pm, Monday through Friday at YWCA. Off-site location hours are 6:30AM to 5:30PM.What type of care do you need? Before School Care After School Care Before AND After School Care Before School Care: Monday Tuesday Wednesday Thursday Friday Before school only. Select all days which apply.After School Care: Monday Tuesday Wednesday Thursday Friday After school only. Select all days which apply.Before AND After School Care: Monday Tuesday Wednesday Thursday Friday Select all days which apply.Has your child attended YWCA Young Wonders in the last year? Yes No Parent/Guardian InformationParent/Guardian 1 Name: First Last PhoneEmail Parent/Guardian 2 Name (if applicable): First Last PhoneEmail PaymentA $50.00 non-refundable, non-transferable, registration fee is due at this time.Registration Fee Payment(Required) Registration Fee ($50.00) Total
