• Infant, Toddler, Preschool Health Forms

    Completion of these questions does not confirm your child's enrollment. You must follow up with Director for program availability and pay the registration fee (if required).
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  • Child / Family Information Survey

  • Parent / Gaurdian Involvement Survey

  • Parent / Guardian Statement of Understanding and Policies

  • Policies and Procedures/Handbooks

  • The YMCA of Central Ohio’s Employee Code of Conduct related to the interactions between YMCA Staff and program participants, members and volunteers. The YMCA of Central Ohio is committed to keeping its program participants, members, volunteers, staff and the community safe.

    We feel that it is important to share with you the expectations that we have of our staff regarding their interactions with program participants, members, volunteers, fellow staff, and the community. Please review and retain a copy of this document describing our expectations.

     

  • Parent/Guardian 1
  • Parent/Guardian 2
  • Emergency Contacts/Authorized Pickup

    Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
  • Emergency Contact #1 - Required
    • Emergency Contact #2 
    • Emergency Contact #3 
    • Emergency Contact #4 
  • Medical / Health Information

  • ALL PARENTS/GUARDIANS of children who have NOT YET ATTENDED KINDERGARTEN are required per the State of Ohio to provide an updated Child Medical Physical ANNUALLY.  This form must be turned into the program director by your child's first day at the center. Please CLICK HERE to access the form.

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  • *A JFS 01236 "Medical/Phsyical Care Plan" or equivalent form and if administering medication, a JFS 01217 "Request for Administration of Medication" must be completed.

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  • *A JFS 01236 "Medical/Phsyical Care Plan" or equivalent form and if administering medication, a JFS 01217 "Request for Administration of Medication" must be completed.

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  • *JFS 01217 "Request for Administration of Medication" must be completed and kept on file for each medication, food supplement or medical food.

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  • *Written instructions from the child's health care provider must be on the JFS 01217 "Request for Administration of Medication."

  • Plan for Health Conditions

  • If care is provided for a child who has an ongoing health condition that requires child specific care or may require a medical procedure, the parent/guardian shall complete this form.  

    A separate plan must be written for each condition that requires different actions to be taken.

    If the child has more than 1 medical condition that requires different actions to be taken, answer the fields below for the first condition. Additional conditions must be addressed using this separate form.

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  • Additional Medication (Administration of Medication JFS 01217)

  • If your child's medication meets any of these criteria:

    1. A physician's instruction is needed for a nonprescription medication (e.g. child is underage or underweight per the label instructions); or
    2. It is a sample medication without a prescription label; or
    • The nonprescription medication is to be given longer than three consecutive days within a fourteen day period or is a topical product or lotion that is being used for a skin ailment and is to be given no longer than fourteen consecutive days; or
    1. The child is on a modified diet (an entire food group is eliminated); or
    2. The medication contains codeine or aspirin.

    Please complete this form and Box 2 must be completed by a licensed physician, licensed dentist, or an advance practice nurse. 

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  • United Way Required Documentation

  • YMCA Families: We ask that you complete this form for your child to help us maintain our United Way of Central Ohio funding.  United Way enables the YMCA to offer reduced program fees to eligible families.  This information is kept strictly confidential.  Thank you!


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