Basic Information

Name of Child
Child Home Address
Select School Your Child Attends

About Your Child

Does your child have any special needs, medical concerns, allergies, or physical limitations? Please share any information about your child that would be helpful to our staff:
Parent/Guardian 1:
Parent 1 Address
Parent/Guardian 2
Parent 2 Address
Huntington School District: Programs at Southdown & Washington Primary SchoolsHuntington School District: Programs at Southdown & Washington Primary Schools
7:00am-Start of School. Students from Woodhull/Jefferson/Jack Abrams will be bused to/from Southdown. Students from Woodhull/Flowerhill/Jack Abrams will be bused to/from Washington.
Dismissal-6:30pm. Students from Woodhull/Jefferson/Jack Abrams will be bused to/from Southdown. Students from Woodhull/Flowerhill/Jack Abrams will be bused to/from Washington.
7:00am-Start of School and Dismissal to 6:30pm. Students from Woodhull/Jefferson/Jack Abrams will be bused to/from Southdown. Students from Woodhull/Flowerhill/Jack Abrams will be bused to/from Washington.
S. Huntington School District: Programs held at Oakwood & Countrywood Primary Schools
7:00am-Start of School. Students from Maplewood will be bused to/from Countrywood. Students from Birchwood will be bused to/from Oakwood. 6th Graders from Silas Woods have a choice of location.
Dismissal-6:30pm. Students from Maplewood will be bused to/from Countrywood. Students from Birchwood will be bused to/from Oakwood. 6th Graders from Silas Woods have a choice of location.
7:00am-Start of School and Dismissal-6:30pm. Students from Maplewood will be bused to/from Countrywood. Students from Birchwood will be bused to/from Oakwood. 6th Graders from Silas Woods have a choice of location.
Cold Spring Harbor School District: Program held at Huntington YMCA
AM Care: Not Available. PM Care: Dismissal - 6:00pm. Bus will be provided by district for PM program.
A full-day school age child care program for students remote learning or on a hybrid school schedule (i.e., Group A, Group B). Program runs from 8:00am-6:00pm and extended hours are available from 7:00am-8:00am.
Y STUDENT SUPPORT CENTER: Select days of the week to attend. Check all that apply.
Parental Agreement

No refund or credit for days absent or missed. Suspension from this program is at the discretion of the YMCA of Long Island. If your child is not picked up by the program end time, there will be a $25 charge for the first five minutes and then $1 every minute you are late. Written notice is required for all withdrawals or changes at least 15 days prior to the change. There is a $10 fee for all withdrawals and changes. I give permission for my child to participate in all SACC activities planned for the days he/she attends. I understand that I must have a Medical Consent Form signed by a Parent or Guardian on file at the YMCA before the first day my child begins the SACC program. I also give permission for my child's photograph for be taken to use in YMCA marketing materials. 

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