ELC Change in Information Form

Child's Name

Child's Birthdate

Parent/Guadian Name

Early Learning Center Location

Gainesville Early Learning Center North Hall Early Learning Center

I would like to inform the Georgia Mountains YMCA that my child will not be attending the following dates. Please specify start and end dates. If you are withdrawing your child permanently, please complete an Early Learning Center Withdrawal Form.

Absence Start Date

Absence End Date

Change in Information

Child's Name

New Phone Number

New Address

New Work Phone Number

Change in Pick Up Contact

Add Contact Remove Contact Update Contact

Name of Authorized Pick Up Contact

Address

Relation to the Child

Phone Number

As a registered participant in the YMCA Kid's Time Program, I understand that I must give at least a 10 day notice of my child's (week long or more) absences from the program in order not to be charged for that week. I understand that if I do not give at least a 10 day notice by completing this form, I will be charged in full for that time. I understand I must submit this form with at least a 10 day notice for the changes to be effective.

Parent/Guardian Signature

ELC Change in Information Form

Georgia Mountains YMCA

Our Mission

About Us

Redeem at the front desk for a tour and to Try the Y for free for one day!