Child Care Programs

The Child Profile Intake Form is required so that the YMCA staff have the needed information in case of an emergency, to contact families and to help your child/camper be successful in our programs. Be sure to include two emergency contacts that are different than the primary or secondary guardian. This form also helps us to assign huddles, give counselors insights and help with check-in and check-out each day. All information is confidential and is only given to staff on an as-needed basis.

Proof of Child Identity and Age

In accordance with Virginia childcare licensing requirements, proof of your child’s identity must be provided at enrollment. Acceptable forms of identification include:

• Certified birth certificate
• Birth registration card
• Notification of birth, i.e., hospital, physician, or midwife record
• Passport
• Copy of the placement agreement or other proof of the child’s identity from a child placing agency
• Original or copy of a record or report card from a public school in Virginia
• Signed statement on letterhead stationery from a public school principal or other designated official that assures the child is or was enrolled in the school
• Child identification card issued by the Virginia Department of Motor Vehicles

Physical Forms

In accordance with the Virginia Licensing requirements, the Physical for children 2 through 5 years of age must be provided annually and have been performed within 12 months of the first date of attendance to meet licensing obligations for physical records. For Children 6 years and older, the Physical must be provided upon enrollment. The child’s most recent physical is satisfactory. The physical must be signed and dated by the physician.

Physical Forms

Immunization Forms

In accordance with the Virginia Licensing requirements, the immunization for children 2 through 5 years of age must be provided annually prior to the first date of attendance to meet licensing obligations for immunization records. Update of additional immunizations between the child’s fourth and sixth birthday must be provided to the YMCA.

Parents or guardians seeking an exemption from immunization requirements must provide the YMCA with a Virginia Department of Health-approved exemption form. The from must be completed, signed, dated by parent or guardian, and notarized.

Immunization Page

Virginia Religious Exemption Immunization Form

Allergy Action Plans

In accordance with state requirements, if a food allergy is noted on the physical by the physician or listed by guardian on the Youth Development application, the YMCA is required to have a completed Allergy Action plan for the child prior to the child’s first day of attendance in the program. The allergy action plan includes the physicians’ plan on action in the event of suspected and confirmed allergic reaction. The allergy action plan must be signed and dated by the physician and guardian.

Allergy and Anaphylaxis Emergency Action Plan

Medical Action Plans

If your child has a medical diagnosis listed by you or the child’s physician, an action plan will be required so that staff may know how to respond in case of a medical emergency. Examples of these include asthma action plans, diabetes plan, seizure plan, etc. The action plan must be signed and dated by the physician and guardian.

Medical Action Plan

Medication Authorization Forms

• A Medication Authorization form must be completed by the parent/guardian for medications being taken over a period of time no greater than 10 days.

• A Medication Authorization form must be completed by the parent/guardian AND the prescribing physician for long-term medications for such things as asthma, ADHD, Epi-pen, etc. Over-the-Counter Skin Products Authorization form, if applicable.
• The YMCA requires a completed Medication Authorization Form (MAT) form for each medication administered during the before- and after-school program.

• If required medication will not be provided to the YMCA a “Medication NOT PROVIDED FOR YMCA” form must be completed.

• A site may allow a child to have certain medication on his or her person and self-administer if the child is 9 years of age or older and we have written permission from the physician. In some cases the medication might be required to be kept locked in a bag or container.

If the guardian desires to purchase sunscreen and/or insect repellent for their child, the Department of Education requires that the guardian complete an Over-the-Counter Skin Products Authorization form with information about the sunscreen and/or insect repellent selected by the guardian.

Medication Authorization Form

Medication Not Provided Form

For your review and records, the programs’ respective Parent Handbooks are also listed below along with some helpful information the YMCA wants you to know about Child Abuse Prevention.

• Parent Handbook

PlayerSpace is our comprehensive digital system designed for parents whose children are enrolled in our childcare programs to easily upload required licensing documents and waivers. In addition, you will receive program updates, announcements and much more!

Parents will be reminded on a regular basis to turn in forms. Once forms are uploaded, a site staff member will then go in and approve or state any necessary changes that need to be made before compliant.