Parent/Guardian #1 Information
     
Note: We will primarily contact you through the email address provided below. Please double-check the email address provided to ensure its accuracy.  


* First Name 
* Last Name 
* Relationship 
* Email 
* Address 
* City 
* State 
* Zip 
* Phone 
* Phone Type 
  Cell Network    Employer 


Parent/Guardian #2 Information
  First Name   Last Name 
  Relationship    Email 
  Address   City 
  State   Zip 
  Phone 
  Phone Type 
  Cell Network    Employer 


Emergency Contact(s)/Authorized Pickup(s) Other Than Listed Above
* First Name 
* Last Name 
* Relationship 
  Phone 
* Emergency Contact 
* Authorized Pickup 
   
  First Name   Last Name 
  Relationship    Phone 
  Emergency Contact    Authorized Pickup 
   
  First Name   Last Name 
  Relationship    Phone 
  Emergency Contact    Authorized Pickup 
   
  First Name   Last Name 
  Relationship    Phone 
  Emergency Contact    Authorized Pickup 
   
  First Name   Last Name 
  Relationship    Phone 
  Emergency Contact    Authorized Pickup 


Terms of Agreement
     
FINANCIAL AGREEMENT
Full payment is due at the time of registration. Registration is not considered complete until payment is received in full. Payment is non-refundable after the 2nd class takes place, regardless of student’s attendance. Late charges assessed if refund requested after 1st class takes place.

WAIVER
I acknowledge and agree that my child’s participation in the Y’s nursery electives involves inherent risks and I hereby release and hold harmless the YM & YWHA of Washington Heights and Inwood, its officers, directors, agents, employees, volunteers, independent contractors, and any other person associated with the YM & YWHA of Washington Heights and Inwood, from any liability for injury to my child to the greatest extent allowed by law. I freely assume said risks and any resulting expense for me and on behalf of my child, and I hereby release, waive, discharge, and agree not to sue the YM & YWHA of Washington Heights and Inwood (or its associated persons listed above) if a known or unknown hazard relating to any activity causes injury to my child.  
* Indicate 
     
In lieu of a signature, I enter my name and the date below.  


* Name 
* Date 


How did you hear about Elective Classes at the Y?
* Indicate 
  Other 


Registered Child(ren)

To register your child(ren), please click Add a Child.



Privacy Policy
We keep your personal information private and secure. When you make a payment through our site, you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly credited to your account.

Contact Us
YM & YWHA of Washington Heights and Inwood
54 Nagle Avenue, New York City, NY 10040
Tel: (212) 569-6200 ext. 200
eweinberg@ywashhts.org
©2018 SofterWare, Inc. v.2018.01.02-B