You must have JavaScript enabled to use this form. 2025-2026 BASE Waiting List RequestThank you for your interest in our Before and After-School Enrichment (BASE) programs. If the program you’re interested in is currently full, please complete this form. We will contact you via email if space becomes available.If you do not yet have an account in our registration system, you can create one at my.seattleymca.org. Be sure to include the primary adult and all participants you’d like to add to the waitlist. We also recommend saving a payment method in advance to help streamline the registration process.Completing these steps ahead of time will help prevent any delays should a spot open up. . Primary Guardian Information First Name Last Name Relationship to Participant Does the participant reside with you? Select optionAll of the timeMost of the timeSome of the timeParticipant does not reside with me Street address City State Select stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Postal or Zip Code Phone Number Email Address . Participant Information First Name Last Name Date of birth Grade in 2025-2026 school year? Select gradeKindergarden1st2nd3rd4th5th6th What school will your child be attending in the 2025-2026 School Year? What school district is your school in? Select districtAuburn School DistrictEdmonds School DistrictHighline School DistrictKent School DistrictLake Washington School DistrictNorthshore School DistrictSeattle School DistrictShoreline School DistrictSnoqualmie School District Add another participant First Name Last Name Date of birth Grade in 2025-2026 school year? Select gradeKindergarden1st2nd3rd4th5th6th What school will your child be attending in the 2025-2026 School Year? What school district is your school in? Select districtAuburn School DistrictEdmonds School DistrictHighline School DistrictKent School DistrictLake Washington School DistrictNorthshore School DistrictSeattle School DistrictShoreline School DistrictSnoqualmie School District Add another participant First Name Last Name Date of birth Grade in 2025-2026 school year? Select gradeKindergarden1st2nd3rd4th5th6th What school will your child be attending in the 2025-2026 School Year? What school district is your school in? Select districtAuburn School DistrictEdmonds School DistrictHighline School DistrictKent School DistrictLake Washington School DistrictNorthshore School DistrictSeattle School DistrictShoreline School DistrictSnoqualmie School District . Waitlist Options Waitlist Options I would like to be included on the waiting list for the following options. Please click on all options that you are interested in. Not all options will be available at all locations. Full-time Monday-Friday Before and After School Full-time Monday-Friday After School Only Full-time Monday-Friday Before School Only Part-Time Monday/Wednesday/Friday After School Part-Time Tuesday/Thursday After School Only Part-Time Monday/Wednesday/Friday Before School Part-Time Tuesday/Thursday Before School Only . Emergency ContactAn emergency contact is an adult who acts as an alternate guardian during an emergency when legal guardians cannot be reached. Trusted relatives and close family friends who live nearby make good emergency contacts. First Name Last Name Phone Number Email Address . Allergies & Dietary RequirementsIf the participant has any medication allergies, food allergies, and/or special dietary requirements, please download and complete the Allergy Plan, including a physician's signature, and re-upload it in the post-registration paperwork. The participant will not be able to attend the program until we have all medication and paperwork completed and on-site. Allergies Options Does the participant have any known medication allergies, food allergies, and/or special dietary requirements? If yes, please list below and include the severity, their reaction, and next steps if exposed. (Click on all that apply, at least one check box is required.) No Yes, this child has a medication allergy Yes, this child has a food allergy Yes, this child has special dietary requirements Other Additional Allergies Please provide more information about any known medication allergies, food allergies, and/or special dietary requirements. . Medical Conditions & Medications Medical Conditions & Medications Options Are there any activities the participant should be exempted from for health reasons? Does the participant have any past or current medical conditions? If yes, please provide more information below. (Click on all that apply, at least one check box is required.) No Yes, the participant should be exempt from the activities below for health reasons. Yes, the participant has had the listed previous health conditions. Yes, the participant has the currently listed health conditions. Other Additional Medical Conditions & Medications Please provide more information about exempt activities or past and/or present health conditions. If the participant requires medication during program hours, please bring a copy of the completed and signed medication authorization form to the first day of program with the participant’s medication in the original packaging. The participant will not be able to attend the program until we have all the medication and paperwork completed and on-site. If the participant has diabetes, there may be additional required forms. . Behavioral & Developmental Information Medical Conditions & Medications Options Does the participant have any behavioral and/or developmental information we should be aware of in order to best support them? If yes, please provide more information below. No Yes Information about the behavioral and developmental needs If Yes, please provide more information about the behavioral and developmental needs. If you listed behavioral or developmental information, and your child requires support or accommodations, please download and complete the individual care plan form, including a physician’s signature if needed. . Acknowledgments & Policies Cancellation Acknowledgment: I understand and agree to the following: Once enrolled, canceling this program requires fourteen (14) days written notice via cancellation web form prior to the first (1) of the month. Any participants providing notice less than fourteen (14) days prior to the first of the month will be charged for the full upcoming month of tuition. Annual registration fees are non-refundable and non-transferable. Failure to complete requirements for attendance, including Yes, I understand. Confirmed Registration Acknowledgement: I acknowledge that once enrolled, finalizing my registration is dependent upon completing any assigned post-registration paperwork that is to be submitted by the participant’s guardian and approved by Y staff. The Y staff are required to review and approve or review and contact me for additional information within 10 business days of receiving the participant’s post-registration paperwork. I acknowledge that failure to complete the assigned post-registration paperwork will leave this registration incomplete and the participant will not be able to attend program. Yes, I understand.