Childcare Change Request Form

Summit Area YMCA Childcare Change Request

Please note: If you need to request changes for multiple children, a separate request form must be completed for each child.
Request type:
Child's Name

First NameLast Name
Your Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
Phone number
Format: 000-000-0000.
Branch:

CHILDCARE CHANGE REQUEST POLICY

All requested changes are scheduled to become effective the 1st of the month. Changes must be requested six [6] weeks prior to the start of the month and submitted no later than the 20th of the billing month (example: a program change starting in December should be submitted by October 20). A change request form must be completed for all program changes. There is a $20 processing fee for schedule changes. There will be an additional $10 late processing fee for requested changes that come in after the change deadline described above. All applicable payments will be charged to your current payment method on file unless requested.
Which program(s) is your child currently enrolled in?
Please confirm which school:

Change Effective as of:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

REQUEST PROCESSING & CONFIRMATION

By submission of this form, you agree that you have read and understand the Summit Area YMCA's childcare change request and billing policies as stated above.

If any additional information or clarification is needed to process your request, we will reach out to you shortly. Once your request has been completed, you will receive an email confirmation from our Child Care team. Credit/refunds may take up to two (2) weeks to process.
Additional clarification, details or comments?
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Summit Area YMCA Childcare Change Request