Greater Peoria Family YMCA

Peoria, Illinois

GREATER PEORIA FAMILY YMCA

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Change of Status

Camp & Y-Achievement Before and After Care

Child Name*
First Last
Date of Request*
Date Format: MM slash DD slash YYYY
School*
Effective Date of Change*
Date Format: MM slash DD slash YYYY
I am dropping my child from the program
- Yes
- No
This change will continue until what date, if longer than one week
Date Format: MM slash DD slash YYYY
I am changing the schedule that child will be attending to:
Camp
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Before School
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
After School
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Reason for Change:
Please check the box to accept the following:*
- I agree that I am responsible for all fees incurred while my child is enrolled in the Camp or Y-School Age Program and that I agree to the above schedule and/or fee change. I acknowledged that this request must be submitted at least a week in advance of the change and am responsible for any fees incurred until this change goes into effect.
Your Email*
Name
This field is for validation purposes and should be left unchanged.

Program Registration Instructions

Facility Hours:

Monday – Friday | 5:00 am – 9:00 pm
Saturday | 7:00 am – 7:00 pm
Sunday | 11:00 am – 5:00 pm

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Copyright © 2021 Greater Peoria Family YMCA

Greater Peoria Family YMCA
7000 North Fleming Lane
Peoria, IL 61614
Phone: 309.692.7631
Fax: 309.692.4892

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