Y BASE CHANGE/CANCELLATION FORM
Staff initial:_______________
Date:___________________
Use this form only if child is already registered (please use a separate form for each child).
All changes must be completed on the Wednesday 2 WEEKS PRIOR to the start of a two week session. Sessions and their
deadlines are located on the backside of this change form.
Select purpose of form:
CANCEL SESSION
CHANGE ATTENDANCE
ADD EXTRAS
Student’s Name__________________________________________ Parent/Guardian’s Name_____________________________________________________
Dates of Session___________________________________________ School_________________________________________________________________________
CANCEL 2-WEEK SESSION:
Current Registered Session:________________________________________________________________________________________________________________
Reason for Cancellation?:___________________________________________________________________________________________________________________
Parent/Guardian Signature:_________________________________________________________________________________________________________________
CHANGE ATTENDANCE:
Current dates:
New dates:
Daily Pricing
Mon. AM
Tue. AM
Wed. AM
Thur. AM
Fri. AM
Mon. PM
Tue. PM
Wed. PM
Thur. PM
Fri. PM
Mon. AM
Tue. AM
Wed. AM
Thur. AM
Fri. AM
Mon. PM
Tue. PM
Wed. PM
Thur. PM
Fri. PM
1 day $08-AM | $12-PM
2 days $16-AM | $24-PM
3 days $24-AM | $36-PM
4 days $32-AM | $48-PM
5 days $38-AM | $58-PM
$90-BOTH AM & PM
*$4 addition charge when enrolled
on Thursday PM
Is this a one-time change or a permanent change?:___________________________________________________________________________________
_
Parent/Guardian Signature:_________________________________________________________________________________________________________________
ADD EXTRAS: Please circle all that apply.
Thursday Early Release (until 3:45PM) : $4
Half Days (until 3:45PM) : $11 (until 6:00PM) : $23
Monday, November 7
Tuesday, March 28
School’s Out Fun Days at the West Suburban YMCA : $30 Y members / $38 Program Participants
(Payment is due in full at time of registration)
Wednesday, November 23
Friday, November 25
Monday, December 26
Tuesday, December 27
Wednesday, December 28
Thursday, December 29
Friday, December 30
Monday, January 2
Monday, January 23
Friday, February 17
Monday, April 10
Tuesday, April 11
Wednesday, April 12
Thursday, April 13
Friday, April 14
Monday, April 17
PAYMENT INFORMATION: Name on card: _____________________________________________________________ CVV Code:____________
Expiration Date (month/year):_________Card Number:________________________________________________ Zip Code: _____________________
Please scan and email your changes to [email protected], or you may drop off your change form at the West
Suburban YMCA, located at 22420 N. 124th St., Wauwatosa, WI, 53226. Change forms can also be given to your child’s
YBASE site supervisor.
*They will receive a receipt within 5-8 business days.
REGISTRATION AND CHANGE DEADLINE & TUITION DRAFT DATE
2 WEEK ENROLLMENT SESSION
REGISTRATION & CHANGE DEADLINE
TUITION DRAFT DATE
October 10, 2016 – October 21, 2016
October 24, 2016 - November 4, 2016
November 7, 2016 – November 18, 2016
November 21, 2016 - December 2, 2016
December 5, 2016 – December 16, 2016
December 19, 2016 – December 30, 2016
January 2, 2017 – January 13, 2017
January 16, 2017 – January 27, 2017
January 30, 2017 - February 10, 2017
February 13, 2017 – February 24, 2017
February 27, 2017 - March 10, 2017
March 13, 2017 – March 24, 2017
March 27, 2017 - April 7, 2017
April 10, 2017 – April 21, 2017
April 24, 2017 - May 5, 2017
May 8, 2017 – May 19, 2017
May 22, 2017 - June 2, 2017
June 5, 2017 – June 9, 2017 (1 week only)
Wednesday, September 28
Wednesday, October 12
Wednesday, October 26
Wednesday, November 9
Wednesday, November 23
Wednesday, December 7
Wednesday, December 21
Wednesday, January 4
Wednesday, January 18
Wednesday, February 1
Wednesday, February 15
Wednesday, March 1
Wednesday, March 15
Wednesday, March 29
Wednesday, April 12
Wednesday, April 26
Wednesday, May 10
Wednesday, May 24
Wednesday, October 5
Wednesday, October 19
Wednesday, November 2
Wednesday, November 16
Wednesday, November 30
Wednesday, December 14
Friday, December 23*
Wednesday, January 11
Wednesday, January 25
Wednesday, February 8
Wednesday, February 22
Wednesday, March 8
Wednesday, March 22
Wednesday, April 5
Wednesday, April 19
Wednesday, May 3
Wednesday, May 17
Wednesday, May 31
*Different tuition due date because of Winter Break
*They will receive a receipt within 5-8 business days.