K12 App - YMCA of the Roses

Student Application

Child's First Name

Child's Last Name

DOB

Age

Gender

Male

Female

Parent1/Guardian1 First Name

Parent1/Guardian1 Last Name

Parent2/Guardian2 First Name

Parent2/Guardian2 Last Name

Address

City

State

Zip

Phone Number

Email Address

School

Grade

Teacher's Name (Homeroom, Adviser, etc.)

Will your child be able to attend workshops once a week for 90 minutes?

No Yes

Which is the best day for your child to attend the workshops starting at 5:30PM?

Tuesday Wednesday