Childcare Interest Form

Thank you for your interest in Childcare at the Y! Please fill out the form below to start your child's journey at the Valparaiso Family YMCA!

Parent First Name *

Parent Last Name *

Phone Number *

Email Address *

Child First Name *

Child Last Name *

Child Date of Birth *

Month

Day

Year

Choose a Childcare Program *

Infant Care (Little Angels Learning Center)

1 Year Olds (Little Angels Learning Center)

2 Year Olds (Little Angels Learning Center)

2 Year Olds (Main Y Branch)

3-5 Year Olds (Little Angels Learning Center)

3-5 Year Olds (Main Y Branch)

Preferred Start Date *

Month

Day

Year

I agree that if my contact information should change it is my responsibility to call the YMCA childcare department to give them updated information. *

Yes, I understand

I understand that after I have been contacted by phone/email, I have 48 hours to reply, or my name will be taken off the list and the Y will fill the opening with another child. *

Yes, I understand

I understand that if enrolling my child in a 3- 6 year old in a classroom indicates that they are FULLY potty trained. Fully potty-trained means they are self-sufficient (able to handle the whole process in the bathroom with little or no help). *

Yes, I understand

Leave this field blank

Valparaiso Family YMCA

You are here

Mission Statement

Connect

Search form

Valparaiso Family YMCA

Childcare Interest Form

You are here

Mission Statement

Connect