YMCA of South Florida

Late Pick-Up Acknowledgement

21st CCLC Sites
Date:

MonthDayYear
Date
Location:
Staff Name:

First NameLast Name
Parent Name:

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

First NameLast Name
Check One:
Pick-Up Time:

Hour Minutes

AM/PM Option
Minutes Late:
Operations Email:
Parent Acknowledgement
Late Pick-Up Policy:

The YMCA program closes at 6:00 pm. 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: