Snow Squad Registration

Home Health & Wellness Youth Development Snow Squad Registration

Snow Squad Registration

When school is closed due to snow, YWCA Central Massachusetts stays open! Snow Squad offers a structured, fun-filled day including organized gym activities, swimming, creative activities, board games, outdoor play, and more!

Child's Name*
First Last
Date of Birth*
Age*
School Attending:*
Grade Level*
Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Alternate Phone Number
Email
How did you hear about Snow Squad?
- School
- Friend/Family
- Advertisement
- Social Media
Optional Demographic Information
Child's Gender
Child's Race/Ethnicity (select all that apply)
- American Indian/Alaskan Native
- Asian
- Black/African-American
- Hawaiian Native/Pacific Islander
- Hispanic/Latino
- White/Caucasian
- Other
Number of people in your household (including adults):
Total Annual Household Income
Please combine income of ALL household occupants.
Health Information
Are your child's immunizations up to date?*
- Yes
- No
Please list any allergies:
Does your child have any health problems or medical conditions?*
- Yes
- No
If yes, please list:
Medications:
Note: YWCA staff are NOT able to hold, store, or administer medication. If your child needs medication during the program, please speak to the Lead Youth Development Instructor in advance to discuss arrangements.
Health Insurance
Child's Physician
First Last
Physician's Address
Street Address Address Line 2 City State ZIP Code
Physician's Phone
Emergency Contacts (when parent/guardian cannot be reached)*
Click the '+' to add contacts (maximum 3)
Name Phone
Medical Emergency Treatment Consent
I hereby give the YWCA permission to administer basic first aid and/or CPR to my child and/or take my child to the hospital for medical treatment when I cannot be reached or when my delay would be dangerous to my child’s health:*
- Yes
- No
Permissions
I hereby give permission for my child to go outside for winter activities*
- Yes
- No
I give permission for my child's photograph to be taken for use by YWCA Central Massachusetts in program brochures, annual report, website, social media, other promotional materials, and for release to local newspapers.*
- Yes
- No
Pick-Up Agreement
*
- I understand that my child must be picked up by 4:00 PM. In the event that a State of Emergency is declared while your child is at the YWCA, you will be expected to pick him/her up within an hour.
CAPTCHA
By clicking submit, you are completing your child's registration for Snow Squad at YWCA Central Massachusetts. You may now drop your child off for Snow Squad at YWCA during any Worcester Public Schools snow day.