special fun filled YMCA Summer Program encourages individual growth and fosters self-esteem. The program includes water play, art, music and creative play that challenge fine and large motor skills. Our beautiful outdoor woodland setting and two playgrounds allow for additional science and nature-based activities to enrich each child’s experience. Y’S BEGINNINGS 18 PARKSIDE DRIVE SUFFERN, NY 10901 Y’S Beginnings Toddler and Preschool Toddler & Preschool Program For rainy days, we have a large indoor playroom. The children will be going on picnics and walks to the nearby duck pond. The summer program provides a stress-free way to ease into a preschool setting as well as to maintain an already established routine. If you have any questions, please call Suzette Venner at (845) 357-3223. Y’S BEGINNINGS 18 PARKSIDE DRIVE SUFFERN, NY 10901 845 357 3223 FAX: 845 357 6960 WWW.ROCKLANDYMCA.ORG SUMMER REGISTRATION FORM Registration begins March 17, 2014. Register early as space is limited. To register, follow the steps below. Return this form and a check (made payable to the Rockland County YMCA) to Y’s Beginnings at 18 Parkside Drive, Suffern, NY 10901. STEP 1 - Choose a program: q PRESCHOOL PROGRAM: Children need to be 3 to 5 years old by December 1, 2014 and must be toilet trained. q TODDLER PROGRAM: Children need to be 2 to 3 years old by December 1, 2014 and do not need to be toilet trained. STEP 2 - Choose days-a-week: STEP 4 q Member #_______________________________ q New Member ($80 fee) q Non-Member STEP 5 - Calculate Tuition: Days Indicate attendance during two-week session: STEP 3 - Choose session(s): q Session 1: 6/30 - 7/11 (no camp 7/4, see tuition note)* q Session 2: 7/14 - 7/25 q Session 3: 7/28 - 8/8 q Session 4: 8/11 - 8/22 Please make checks payable to Rockland County YMCA Payments are non-refundable after June 1, 2014 STEP 6 An $80 YMCA annual membership is required or a non-member fee must be paid for all program participants. 9:30 a.m. to noon q two days a week (T/Th) q three days a week (M/W/F) q five days a week (M/T/W/Th/F) - Membership status: Member Tuition Fee Non-Member Tuition Fee 2 $90 $110 3 $130 $150 5 $180 $200 How many sessions? Street City State Home Ph# Cell Ph# Sex Zip Age Birthdate M/F / Mothers Daytime Ph# X $90 Tuition Fee + $80 Member Fee = (if applicable) $260 TOTAL DUE ( ) Tuition Fee + Member Fee (if applicable) = *Deduct $20 from Session 1 if registering for 3 or 5 days TOTAL AMOUNT ENCLOSED: $ TOTAL DUE Mothers Cell Ph# ( ) Fathers Name Fathers Daytime Ph# X / Mothers Name FILL IN BELOW: How many sessions? Child’s Name Allergies (list all) EXAMPLE: 2 - Fill in information: ( ) Fathers Cell Ph# ( ) Emergency Contact Name (other than parent) Emergency Daytime Ph# ( ) Emergency Cell Ph# ( )