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Y-Club

Youth Program Forms

Thank you for registering for one of the Y's youth programs! With many of our programs being licensed, we require additional paperwork to be on file before we care for your child(ren).

Please note, each admission agreement is program-specific.

Building Blocks Preschool Health Appraisal (to be filled out by physician)
Admission Agreements
Child Information Record		 Return completed forms to Kelly Freye at kfreye@ymcagm.org
or drop them off at the Y.
Young Adventure Camp (BHSJ) Health Appraisal (to be filled out by physician)
Admission Agreements
Child Information Record		 Return completed forms to Marissa Stanage at mstanage@ymcagm.org
or drop them off at the Y.
Gla-Da-Wen-Ta Day Camp Admission Agreements
Child Information Record		 Return completed forms to Marissa Stanage at mstanage@ymcagm.org
or drop them off at the Y.
Y-Club
St. Joseph Public Schools & Lakeshore Public Schools		 Admission Agreements
Child Information Record		 Return completed forms to Ryan Kitron at rkitron@ymcagm.org
or drop them off at the Y.
Y-Club
Niles Community Schools		 Admission Agreements
Child Information Record		 Return completed forms to Paige Carter at pcarter@ymcagm.org
or drop them off at the Y.
Young Adventure Camp (Northside) Health Appraisal (to be filled out by physician)
Admission Agreements
Child Information Record		 Return completed forms to Holly Dienes at hdienes@ymcagm.org
or drop them off at the Y/Northside Child Development Center.
Y-Club (South Bend) Admission Agreements & Child Information Record (English)
Admission Agreements & Child Information Record (Español)
Medication Permission & Instructions (only if needed)		 Return forms to Maycie Wise at mwise@ymcagm.org 
or drop them off at the Y.
YMCA O'Brien Center Summer Day Camp (South Bend) Admission Agreements & Child Information Record (English)
Admission Agreements & Child Information Record (Español)
Medication Permission & Instructions (only if needed)		 Return forms to Maycie Wise at mwise@ymcagm.org 
or drop them off at the Y.