Child Care, Camp and Preschool Forms
Thank you for registering for a YMCA Camp, Child Care or Preschool program!
Even though your camper or student is registered in our online systems, there are a few additional forms and waivers that staff need that are required by the Department of Education as licensed child care centers. Please see below for more information on these forms and waivers and where to upload them.
During the online registration and intake process, most of the information the YMCA is required to have on file will be completed. There are a few forms that do require signatures. Print out the below forms, complete them and upload the completed forms, as needed.
Health History and Intake
The health history intake form is required so that YMCA staff have the needed information in case of emergency, to contact families and to help your child/camper be successful in our programs. Be sure to include two emergency contacts that are different than the primary or secondary guardian. This form also helps us to assign huddles, give counselors insights and help with check-in and check-out each day. All information is confidential and is only given to staff on an as-needed basis.
Physical and Immunization Forms
- Required Medical Forms for Preschool, School-Aged Child Care and Camp
- Formulario de información médica/Informe de examen físico integral
- Combo Camp Release Form
In accordance with Virginia licensing requirements, the PHYSICAL and IMMUNIZATION RECORDS for children 2 through 5 years of age must be provided annually and have been performed within 12 months of the first date of attendance to meet licensing obligations for physical and immunization records.
For children 6 years and older, the PHYSICAL and IMMUNIZATION RECORDS must be provided upon enrollment. The child’s most recent physical is satisfactory. For children entering seventh grade at the time of enrollment, the IMMUNIZATION RECORDS must include immunizations required to enter seventh grade.
For your review and records, the programs’ respective Parent Handbooks are also listed below along with some helpful information the YMCA wants you to know about Child Abuse Prevention.
PlayerSpace is our comprehensive digital system designed for parents whose children are enrolled in our child care programs to easily upload required licensing documents and waivers. In addition, you will receive program updates, announcements and much more!
Parents will be reminded on a regular basis to turn in forms. Once forms are uploaded, a site staff member will then go in and approve or state any necessary changes that need to be made before compliant.
Login to In-Care Parent Overview Video about In-Care
The YMCA believes that income shouldn’t be a barrier to quality programs.
Statement of Understanding
The following Statements of Understanding and Authorization, Releases and Agreements are important for the safety and protection of your child. Please read this information and sign on the last page of the application.
1. I understand that it is my responsibility to sign my child in upon arrival in the morning (Before-School Youth Development programs and Camp) and sign my child out before leaving in the afternoon. There must be an exchange of responsibility from one adult to staff, not from a child to staff. I understand that I am not to leave my child at the YMCA or YMCA program site unless a YMCA staff is present to receive and supervise my child. (See the YMCA Parent Handbook for more information.)
2. I understand that my child will not be allowed to leave the program with an unauthorized person. Any person authorized to pick-up my child must be listed with the YMCA. Additional authorization will only be accepted in writing from the Custodial Guardian(s).
3. I understand that, should a person arrive to pick-up my child who appears to be under the influence of drugs or alcohol, for the child’s safety, staff may have no recourse but to contact the police.
4. I understand the Youth Development program fees, which are as follows.
- i. Automatic Draft is the required method of payment.
- ii. A Registration Fee is due upon enrollment. This fee is non-refundable and non-transferable.
- iii. For Youth Development programs starting less than one week out, one week’s fee is due for each child. This fee is non-refundable and non-transferable.
- iv. In addition, for Camp sessions starting more than one week out, a $10 deposit is due for each session upon enrollment. This fee is non-refundable and non-transferable.
- v. The fixed weekly payment is due each Monday thereafter prior to the week services are rendered, whether an enrolled child is in attendance or not. Drafts are continuous and will occur every Monday. Before-and After-School Youth Development program payments are based on a180-day school calendar and divided equally into weekly payments. Few of the operating costs of the facility are eliminated when a child is absent; we are prepared for each child, each day, whether the child attends or not. Because of the aforementioned, there will not be any refunds, pro-rated fees, vacations, nor free weeks for days absent, including Winter and Spring Break.
5. Additional fees may be assessed for late pick-up of participants, returned drafts and when schools are closed for inclement weather or emergency reasons.
- i. Late Payment: If payment is not made by Friday prior to the start of the next week, you may risk losing your child’s space in the program.
- ii. Late Pick-up fee: A late fee of $1.00 per minute, per child, will be charged for any child not picked-up by the scheduled end of day. The balance will be drafted at the YMCA’s earliest convenience.
- iii. Returned Draft fees: Should your bank or credit card issuer for any reason not honor your draft, a return payment fee of $30 or less will be assessed on your account in addition to the program payment due. This is also in addition to any service fee your bank may charge. Your account will be automatically re-debited on the next day for payment of a draft not honored.
- iv. Unexpected Full Day fee: If schools close unexpectedly for weather or other emergencies, the YMCA will hold a full day of care at the branch, if possible. If you choose to bring your child to the YMCA branch for care, the additional fee of $15 per day will be drafted from your account that is on file, in addition to the normal rate. 5. I understand the following additional payment terms,
- v. The aforementioned automatic draft and additional fee structure will remain in effect until all payments have been made for the duration of the program, or for the time the child is enrolled.
- vi. Services will be terminated if outstanding balances (including additional fees assessed for returned drafts, late pick up, etc.) remain unresolved after the Friday following the payment due date.
- vii. To terminate or change your draft, 14 days written notice must be provided via email to email@example.com.
- viii. If the participant becomes a YMCA of Greater Richmond member (as compared to a YMCA Program Participant only), the guardian(s) must notify the Y Engagement and Solutions Center (YES Center) to have the Youth Development program rate and draft adjusted accordingly within two weeks.
Questions regarding your draft should be addressed with the Y Engagement and Solutions Center (YES Center) as soon as possible at 804.649.9622 or at firstname.lastname@example.org. Any error must be identified no later than 60 days from the posted bank or credit card statement date. The YMCA is not responsible for errors occurring later than 90 days from the date of the initial error.
6. For safety reasons, it is extremely important to be able to reach the parent(s)/guardian(s) or emergency contact(s) for a child in the YMCA program. I understand that failure to update the parent(s)/guardian(s) and emergency contact(s) information may result in withdrawal from the program.
7. I understand that YMCA staff and volunteers are prohibited to have contact with children with whom their only relationship is through YMCA programs at any time outside of the YMCA facilities or program(s). This includes babysitting. I also understand that YMCA staff and volunteers are prohibited from transporting children in their personal vehicles.
8. I understand that I can request the Youth Development Emergency Preparedness Plan.
9. I understand that, by state law, the YMCA is mandated to report any suspected cases of child abuse or neglect to the appropriate authorities for investigation.
10. In order to facilitate participation of children with special needs, the YMCA will make reasonable accommodations on an individual basis. I understand that it is my responsibility to notify the YMCA upon registration of my child’s special needs so an individual success plan can be developed to support my child.
11. I understand that YMCA Camps are operated outside and that my child will be outside all day, unless the facility experiences inclement weather or temperatures exceed 90o (on the heat index), at which time the YMCA will modify outdoor activities.
12. I understand that my child may not use a cell phone, I-pad or smart watch in the YMCA program.
13. I agree that I am responsible for providing a copy of my child’s PHYSICAL and IMMUNIZATION RECORDS, as well as PROOF OF IDENTITY, prior to the start of the program. The PHYSICAL and IMMUNIZATION RECORDS provided may be no older than 2 years prior to the date of this application. A copy of the child’s PROOF OF IDENTITY can include: a Birth certificate, report card, Birth registration card, passport, copy of the placement agreement or other proof of the child’s identity from a child placing agency (foster care and adoption agencies).
14. I agree that I am responsible for ensuring that my child does not display any of the below symptoms prior to dropping off my child at the site:
- Vomiting or diarrhea (Child can return to the program when symptom free for 72 hours.)
- Contagious illness evidenced by sniffles, reddened eyes, sore throat, constant cough, difficulty breathing, heavy nasal discharge, headache, etc. (Child can return to the program when symptom free for 72 hours.)
- Child’s temperature > 100* (Child can return to the program when symptom free for 72 hours.)
- Head lice (Child can return once it has been treated. Must be checked by a staff member prior to the student returning.)
- Ring Worm (Must be treated and area must be covered; if it cannot be covered, we will need a doctor’s note for the student to return.)
- I agree to arrange to have my child picked-up immediately after the YMCA notifies me that my child is ill. I understand my child will be separated from his or her peers and placed in a separate room, with proper YMCA supervision, until such time I pick up my child.
15. I agree to inform the site immediately if my child, or any member of the immediate household, has developed a reportable communicable disease, as defined by the State Board of Health, including coronavirus (COVID-19), which must be reported immediately.
- I understand that if I, or any member of my household other than my child in the YMCA program, tests positive for COVID-19 or is suspected of being exposed to COVID-19, that the YMCA will suspend participation in YMCA programs.
16. I, in my legal capacity as the parent/guardian of the minor named below, do hereby acknowledge and agree that participation in Youth Development program activities comes with inherent risks. I have full knowledge and understanding of the inherent risks associated with Youth Development program participation, including but in no way limited to: (1) slips, trips, and falls, (2) aquatic injuries, (3) athletic injuries, and (4) illness, including exposure to and infection with viruses or bacteria. I further acknowledge that the preceding list is not inclusive of all possible risks associated with Youth Development program participation and that said list in no way limits the operation of this Agreement.
17. I understand that the YMCA is taking precautions in accordance with federal, state, and local guidelines and laws to prevent transmission of COVID-19. I understand that participating in Youth Development programs could increase the risk of contracting COVID-19 and that the YMCA in no way warrants that COVID-19 infection will not occur through participation in the Youth Development program.
18. I understand that I can access a copy of the YMCA PARENT HANDBOOK at ymcarichmond.org and understand that it is my responsibility to be aware of all policies therein.
19. I wish to have my child participate in YMCA of Greater Richmond Youth Development programs. In consideration for my child being permitted to utilize the facilities, services, and programs of the YMCA for any purpose, including but not limited to observation or use of facilities or equipment, or participation in any program affiliated with the YMCA, without respect to location, for himself or herself and any personal representatives, heirs, and next of kin (the “Undersigned”):
The UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA, its directors, officers, employees and agents (hereinafter referred to as "Releasees") from all liability to the Undersigned for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the Undersigned, which is in any way associated with the Undersigned’s presence in, upon, or about the premises or any facilities or equipment therein, or participation in any program affiliated with the YMCA, without respect to location.
The Undersigned hereby agrees to indemnify, save and hold harmless the Releasees and each of them from any loss, liability, damage, or cost they may incur which is in any way associated with the Undersigned’s presence in, upon, or about the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with the YMCA. The Undersigned hereby assumes full responsibility for and risk of bodily injury, death, or property damage which is in any way associated with the Undersigned’s presence in, about, or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the YMCA.
The Undersigned further expressly agrees that the foregoing RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT is intended to be as broad and exclusive as permitted by law of the state of Virginia and that if any portion thereof is held invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements, or inducement apart from the foregoing written agreement have been made. The UNDERSIGNED acknowledges that the YMCA of Greater Richmond is a charitable non-profit organization under the laws of the State of Virginia and nothing in this RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT shall be construed as a waiver of charitable non-profit status and/or benefits under Virginia law.
STATEMENT OF AUTHORIZATION
1. My child has permission to be transported by a YMCA vehicle and to participate in all YMCA program activities and related field trips.
2. I have read and understand the Swimming/Wading/Boat Rules found in the Parent Handbook. My child has permission to participate in swimming activities.
3. I authorize my child to participate in camp marksmanship activities: BB guns for kindergarten -5th grade campers (at select camps) and .22 rifles for 6th-8th graders (Camp Thunderbird only).
4. I give the YMCA of Greater Richmond permission for my child to be given cardiopulmonary resuscitation (CPR) and First Aid treatment by a qualified staff member of the YMCA of Greater Richmond. I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I authorize the YMCA of Greater Richmond to obtain immediate medical care and give consent to the hospitalization and performance of necessary diagnostic test(s) upon, the use of surgery on, and/or the administration of drugs to my child if an emergency occurs when I cannot be located immediately. I understand that this agreement may cover only those situations which are true emergencies and only when I cannot be reached. I understand that the YMCA of Greater Richmond will take every effort to contact me and/or my designated emergency contacts. I understand that I will be responsible for payment of medical expenses.
5. I understand and support the Y’s procedures to encourage appropriate behavior of my child and to discipline inappropriate behavior in order to provide a safe and fun environment for all program participants, including suspension and up to termination from the program. (See the YMCA Parent Handbook for more information.)
6. I authorize the YMCA to survey my child regarding his or her feelings and/or participate in focus groups about the YMCA program and what they are learning. I understand that my child’s participation in the surveys are voluntary and strictly confidential.
7. I authorize the YMCA to obtain the following information from my child's school in order to help the Y evaluate its programs: Report Cards, Grades, Attendance Records, Standardized Test Scores (including SOLS, MAPS and any other available scores), Behavior/Discipline Information (including Suspensions/Expulsions), and any other academic or behavioral documentation.
CHALLENGE COURSE AGREEMENT
Children in YMCA childcare programs have the potential to enjoy a Challenge Course experience at three of our local facilities, Camp Thunderbird, Shady Grove and Tuckahoe. As a result, we require that all child care and camp participants acknowledge and agree to the following.
I HEREBY ACKNOWLEDGE AND AGREE on behalf of my child that the use of the Challenge Courses have inherent risks. I have full knowledge of the nature and extent of all the risks associated with the use of the Challenge Courses, including but not limited to:
- All manner of injury resulting in falling off the Challenge Courses;
- Rope abrasion, entanglement and other injuries resulting from activities on or near the Challenge Courses such as, but not limited to, climbing, belaying, rappelling, lowering on rope, rescue systems, and any other rope techniques;
- Injuries resulting from falling climbers or dropping items, such as, but not limited to, ropes or climbing hardware;
- Cuts and abrasions resulting from skin contact with the Challenge Courses;
- Failure of rope, slings, harnesses, climbing hardware, anchor points, or any part of the Challenge Courses’ structures.
I further acknowledge that the above list is not inclusive of all possible risks associated with the use of the Challenge Courses and that the above list in no way limits the extent or reach of this release and covenant not to sue.
I agree to instruct my child to abide by the following Challenge Course safety policies:
- Roped climbers and belayers must wear helmets and harnesses appropriately.
- Participants cannot have gum or candy in their mouth while participating.
- Participants must have appropriate footwear. No open toed shoes.
- Participants must follow all commands and instructions.
- Participants must report immediately all accidents or equipment damage.
Shady Grove Ropes Course’ additional safety policies:
- LOW ROPES: All participants must be 5 years old. A spotter is required.
- HIGH ROPES: All participants must be 11 years old. To belay for high ropes, you must be at least 16 years old.
- Climbers must be roped and belayed through a belay plate. Belays must be anchored.
- Lead climbers must use adequate protection to eliminate the possibility of a ground fall at all times.
Tuckahoe Rockwall additional safety policies:
- Climbers must be roped and belayed through a belay plate. Belays must be anchored.
- Lead climbers must use adequate protection to eliminate the possibility of a ground fall at all times.
- No unbelayed climbing above the bouldering line.
Camp Thunderbird Alpine Tower and Zip Line additional safety policies:
- All participants must be at least 8 years old.
- All participants must have the physical and mental ability to climb a 50 ft tower.
- All participants with long hair must have hair tied up underneath the helmet.
- Participants on the ground must wear helmets while in the “drop zone” underneath the platform.
Camp Thunderbird Aqua Zip Line additional safety policies:
- All participants must be at least 5 years old.
- All participants must wear a lifejacket on the zip line.
The YMCA reserves the right to withdraw the participation of any child for failure to follow the Challenge Course Safety Policies, or for any conduct that is viewed as unsafe or inappropriate. In consideration of the use of the Challenge Courses, I acknowledge that I have read and agree on behalf of my child to abide by the Challenge Course Safety Policies.