Before & After-School Enrichment 

Please fill out the form below to show your interest for Before & After-School Enrichment (BASE) programs in the 2022-23 school year.


Student’s Information

Please provide information for your student(s) so we can place you on the appropriate interest lists. Student one's information is required. If more than two students, please provide additional information in the message box at the bottom of this form.

Student One (Required)

Please select the type of care and day(s) of the week you would like care. (required)
Thank you for considering the Y as a safe place for your child. We seek to partner with you to best support your child’s experience and development. Does your child have any medical or behavioral considerations which may require special attention or care by our Y staff? This could include a documented accommodation (IEP, 504 plan) that would help us best support them. A member of your Y staff team will follow up for more information upon enrollment if you select “YES”.
I understand and agree to the following: Once enrolled in BASE, cancelling this program requires fourteen (14) days’ written notice via cancellation webform. Annual Registration fees are non-refundable and non-transferable; failure to complete requirements for attendance, including paperwork and payment that result in days missed from program will not be refunded or credited.
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Student Two

Please select the type of care and day(s) of the week you would like care. (required)
Thank you for considering the Y as a safe place for your child. We seek to partner with you to best support your child’s experience and development. Does your child have any medical or behavioral considerations which may require special attention or care by our Y staff? This could include a documented accommodation (IEP, 504 plan) that would help us best support them. A member of your Y staff team will follow up for more information upon enrollment if you select “YES”.
I understand and agree to the following: Once enrolled in BASE, cancelling this program requires fourteen (14) days’ written notice via cancellation webform. Annual Registration fees are non-refundable and non-transferable; failure to complete requirements for attendance, including paperwork and payment that result in days missed from program will not be refunded or credited.
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Contact Information

Please provide the contact information of the parent or guardian of the students(s). All fields are required.

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Leave a Message

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