Youth Program Forms

Building Blocks Preschool

Return completed forms to Kelly Freye at kfreye@ymcagm.org or drop them off at the Benton Harbor-St. Joseph YMCA.

• Health Appraisal (to be filled out by physician)
• Admission Agreements
• Child Information Record
• Immunization Records

Gla-Da-Wen-Ta Day Camp

Forms must be turned in prior to attending any days of camp. Return completed forms to Marissa Stanage at mstanage@ymcagm.org or drop them off at the Benton Harbor-St. Joseph YMCA.

• Child Information Record
• Immunization Records (to be filled out by physician)

View All Forms Here

If a child has been enrolled in Y-Club for the current school year, no forms are needed.

Young Adventure Camp

Forms must be turned in prior to attending any days of camp. Return completed forms to Marissa Stanage at mstanage@ymcagm.org or drop them off at the Benton Harbor-St. Joseph YMCA. 

• Admission Agreements
• Child Information Record
• Immunization Records (to be filled out by physician)

View All Forms Here

If a child has been enrolled in preschool for the current school year, only the Admission Agreements need to be signed.

Spring Break Camp

Forms must be turned in prior to attending any days of camp. Return completed forms to Marissa Stanage at mstanage@ymcagm.org or drop them off at the Benton Harbor-St. Joseph YMCA. 

Ages: 3-5

• Admission Agreements
• Child Information Record

View All Forms Here

If a child has been enrolled in preschool for the current school year, no forms are needed.

Ages: 5-12

• Child Information Record
• Immunization Records (to be filled out by physician)

View All Forms Here

If a child has been enrolled in Y-Club for the current school year, no forms are needed.

View All Forms Here

Return completed forms to Kristin McKay-Parrish at kparrish@ymcagm.org or drop them off at the Niles-Buchanan YMCA.

Parent Handbook

Benton Harbor-St. Joseph YMCA Y-Club

St. Joseph Public Schools
Lakeshore Public Schools

• Child Information Record
• Medication Permission & Instructions

Return completed forms to Ryan Kitron at rkitron@ymcagm.org or drop them off at the Benton Harbor-St. Joseph YMCA.

Niles-Buchanan YMCA 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 Niles-Buchanan YMCA.

Forms

Required:​

• Admission Agreements & Child Information Record
• Health and Immunization Records (to be filled out by a physician. Must be updated yearly)

As Needed:

• Medication Permission & Instructions (only if needed)
• Over the Counter Medications (only if needed)
• Immunization Waiver -Medical (to be filled out by a physician. Must be updated yearly)
• Immunization Waiver - Religious (must be updated yearly)

Return forms to Maycie Wise at mwise@ymcagm.org or drop them off at the YMCA O'Brien Center or the Downtown South Bend YMCA.

Indiana Child Care Handbook