Search
508-767-2505
DV Help
Donate Online
Social
Facebook
Twitter
×
Search
About
Our History
Advocacy
Membership
Our Fearless Leaders
Publications
Contact Us
Job Opportunities
Give
News
Renovation
COVID-19 Updates
Racial & Gender Equity
Racial Equity Resources
Racial Equity Workshops
Stand Against Racism
Economic Empowerment
Transitional Housing
Girls CHOICE
Young Parents Program
Health & Wellness
Fitness Memberships
Pool
Women’s Health
Classes & Programs
Pool & Fitness Center Schedules
Personal Training & More
Youth Development
Domestic Violence
Survivor Services
Prevention Education
Community Initiatives & Partnerships
Program History
Domestic Violence 101 Workshops
Child Care
Early Education & Care
Center Sites
Curriculum
School-Age Care
Summer Day Camps
Scamper Camp
Camp Wind-in-the-Pines
Counselor-In-Training
Forms & Handbooks
Fees
Events
Pool & Gym Parties
Facility Rentals
Outdoor Rentals
Blog
Our History
Health & Wellness
Domestic Violence
Child Care
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
*
1
2
3
4
5
6
7
8
Parent/Guardian Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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.
$0 - $18,000
$18,001 - $20,000
$20,001 - $22,000
$22,001 - $24, 000
$24,001 - $26,000
$26,001 - $28,000
$28,001 - $30,000
$30,001 - $32,000
$32,001 - $34,000
$34,001 - $36,000
$36,001 - $38,000
$38,001 - $40,000
$40,001 - $42,000
$42,001 - $44,000
$44,001 - $46,000
$46,001 - $48,000
$48,001 - $50,000
$50,001 - $52,000
$52,001 - $54,000
$54,001 - $56,000
$56,001 - $58,000
$58,001 - $60,000
$60,001 - $62,000
$62,001 - $64,000
$64,001 - $66,000
$66,001 - $68,000
$68,001 - $70,000
$70,001 - $72,000
$72,001 - $74,000
$74,001 - $76,000
$76,001 - $78,000
$78,001 - $80,000
$80,001 - $82,000
$82,001 - $84,000
$84,001 - $86,000
$86,001 - $88,000
$88,001 – UP
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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.
Work at YWCA
Sign Up for Newsletter
Give
×
Get news from YWCA Central Massachusetts in your inbox.
Sign Up!
Privacy by SafeUnsubscribe
English
Arabic
Chinese (Simplified)
Dutch
English
French
German
Italian
Korean
Portuguese
Russian
Spanish