Family YMCA at
Tarrytown,
62 Main Street,
Tarrytown, NY 10591 (914) 631-4807
Parent Statement of Understanding
I, the undersigned, give permission for my child to participate in all activities planned for the days my child attends the Family YMCA at Tarrytown After School Care Program. I give my child permission to participate in supervised out-of-facility trips, including walking trips.
I understand that my child will not be able to participate in the program until I have turned in a signed physical examination. The exam must have been taken within twelve months and all immunizations must be up-to-date.
In case of an emergency, I understand that every effort will be made to contact parents or guardians of my child. In the event that I can not be reached, I hereby give permission to the physician selected by the YMCA staff to care for my child.
I hereby give my consent to the Family YMCA at Tarrytown, and to such other person(s) as the Family YMCA at Tarrytown may designate, to use my name, voice, statements, and portrait or picture (motion or still) for advertising purposes, for purposes of trade, or for any lawful purpose whatever, in any media now known or hereafter developed.
I understand that I am not to leave my child at the YMCA or After School Care (“ASC”) program site unless a YMCA ASC Staff is there to receive and supervise my child.
I understand that my child will not be able to leave the program with an unauthorized person. Any person authorized to pick up my child must be listed on the registration form, or must be arranged separately with the Director of the program.
I understand that if any person arrives to pick up my child who appears to be under the influence of drugs or alcohol, for the child’s safety, staff may have no recourse but to contact the police.
I understand that state law requires the YMCA to report any suspected cases of child abuse or neglect to the appropriate authorities for investigation.
I have read and fully understand the statement above and the policies detailed in the Parent Handbook.