PRIME TIME PLUS
Fall I Registration
Ages 6 Weeks -7 Years Old
Monday – Saturday: pick three hours between 8:30 a.m. and 1:00 p.m. OR
Monday – Friday: pick three hours between 3:45 p.m. and 8:30 p.m.
WEEK AM
M T
W
TH F
S
WEEK PM
M
August 11 – August 16
August 11 – August 15
August 18 – August 23
August 18 – August 22
August 25 – August 30
August 25 – August 29
September 1 – September 6
September 1 – September 5
September 8 – September 13
September 8 – September 12
September 15 – September 20
September 15 – September 19
September 22 – September 27
September 22 – September 26
September 29 – October 4
September 29 – October 3
October 6 – October 11
October 6 – October 10
October 13 – October 18
October 13 – October 17
October 20 – October 25
October 20 – October 24
October 27 – November 1
October 27 – October 31
November 3 – November 8
November 3 – November 7
Time: ______________________
Code: 0421PRIMAM
$15 for Members/$35 Max for 3 or More
T
W
TH
F
Time: ______________________.
Code: 0421PRIMPM
$15 for Members/$35 Max for 3 or More
Prime Time Plus allows children to use Prime Time while their parents leave the building. Children signed-up for Prime Time Plus will be checked into The Family
Prime Time Center and given a yellow bracelet. These children will interact with other Prime Time children and enjoy the same activities. Children will be taken
out of Prime Time at their designated snack time to enjoy their tasty treats packed from home. Please note: snack will be served at 10:30 a.m. and 5:30 p.m.
Please send children with sneakers, an extra change of clothes, and a quick, easy healthy snack.
*Program Refund Policy*
Refunds will be issued if notice is given within three business days prior to the start date of the program. Once the program has started there will be no refunds
issued. The YMCA reserves the right to cancel a program that does not have the minimum enrollment. Programs cancelled by the YMCA will be refunded in full
by check or as a program credit, based upon member’s preference. All refunds must be made through the director of the program.
*For more information please see Program Guide*
Name of Parent/Guardian:
_________________________________________________________________________________________________________
___________________
Address:
_________________________________________________________________________________________________________
_________________________________________
Home #: __________________________________________ Work #:________________________________________ Cell
#:______________________________________________
Emergency Contact Name & Phone #:
_________________________________________________________________________________________________________
_____
Child's Name: _______________________________________________________________________________ Date of Birth:
_____________________ Age: ___________
Allergies
:________________________________________________________________________________________________________
__________________________________________
Child's Name: _______________________________________________________________________________ Date of Birth:
_____________________ Age: ___________
Allergies
:________________________________________________________________________________________________________
__________________________________________
Child's Name: _______________________________________________________________________________ Date of Birth:
_____________________ Age: ___________
Allergies
:________________________________________________________________________________________________________
__________________________________________
I allow the YMCA to use my photograph/my child’s photograph for publicity and marketing purposes.
_________________________________________________________________________________
___________________________________________
Parent/Guardian Signature
Date
Please return complete registration form and payment to the East Area Family YMCA Member Service
desk. All registrations close 2 days prior to the program start date.