YMCA of South Florida

Late Pick-Up Acknowledgement

Fee-Based Sites
Date:

MonthDayYear
Date
Location:
Staff Name:

First NameLast Name
Parent Name:

First NameLast Name
Parent Email:
example@example.com
Finance Email:
Operations Email:
Child's Name:

First NameLast Name
Check One:
Pick-Up Time:

Hour Minutes

AM/PM Option
Minutes Late:
Late Fee Total:
Parent Acknowledgement
Late Pick-Up Policy:

The YMCA program closes at 6:00 pm. A late fee of $15.00 will be assessed 5 minutes after the close of the program and an additional $15.00 for every 15 minutes following. The YMCA reserves the right to terminate participation after the third offense.

If you have any questions regarding your child’s participation in the YMCA program or this late pick-up notice, please contact us at 305-357-4000.

Participant Name: {childsName}

Parent Name: {parentName}

Dated: {date217}
Parent Signature
Should be Empty: