Town of Bay Harbor Residency Verification

Town of Bay Harbor Islands

Residency Verification Coupon Request
Thank you for your interest in the YMCA after-school program in partnership with the Town of Bay Harbor Islands. Please complete this form to verify your residency in the Town of Bay Harbor Islands and qualify for a $25 per month Residency Coupon for the YMCA after-school program upon approval for each child registered in the program.

Application ID
Parent Name

First NameLast Name
Email Address
Phone Number
Format: (000) 000-0000.

Child(ren)’s Name(s) and Grades

Rows	Name	Grade
Child 1
Child 2
Child 3
Child 4

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived at this address?
Do you own or rent your home?

Upload Proof of Residency Document

Acceptable documents: Utility Bill, Lease Agreement, Property Tax Bill, Government Issued ID with Address
Cancelof
Type of Document Provided

I hereby certify that the information provided in this form is true and correct to the best of my knowledge. I understand that providing false information may result in the denial of the $25 per month Residency Coupon and may be subject to further action.
Agreement
Signature
Denial Reason:
Should be Empty: