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School Age Inquiry Form

indicates a required answer

YKids Before and After School Inquiry Form

 
1. *

Today's Date: 
2. *

Parent's First and Last Name:
3. *

E-mail Address:
4. *

Phone Number:
5. *

Child's First and Last Name(s): 
6. *

Please select the school site you are interested in: 

 (1 required)
Horicon Elementary School - Horicon Meadow View Primary - Waupun
Rock River Intermediate - Waupun Jefferson Elementary School - Beaver Dam
Lincoln Elementary School - Beaver Dam Prairie View Elementary School - Beaver Dam
Washington Elementary School - Beaver Dam
7. *

Please select the sessions interested in: 

 (1 required)
Before School After School
Both (Before & After School)
8. *

Member Status:

 (1 required)
Member Non-Member