Children With Special Needs, Additional Information Form

Thank you for your interest in our YMCA Early Learning and Child Development Centers, School Age Child Care and Camp Programs. Our programs welcome children with a wide range of abilities. We understand that some children may need individualized support related to medical, physical, cognitive, or behavioral needs. We evaluate each child’s needs on an individualized basis and work with families to understand how we can best support their success in our group based setting.

We are an independent program, separate from the unified school district, and we operate under our own licensing regulations. Because of this, we do not have access to school district staff or resources during our program hours. However, we are committed to making reasonable accommodations in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

Our goal is to partner with every family to help their child participate meaningfully in our program. If a requested accommodation would fundamentally alter the nature of our program or if a child’s needs cannot be safely met in a group setting even with reasonable accommodations, we will discuss these concerns with the family and explore all available options together.
 

Thank you for sharing information about your child. This form is the first step in an ongoing conversation about how we can best support their needs. A Program Director will follow up with you to review the information . We are committed to making a timely decision regarding enrollment and participation. Please allow at least 10 business days for this process. Submitting this form does not guarantee enrollment or placement in the program; all enrollment decisions are made following an individualized review of each child’s needs and the program’s ability to provide appropriate support.

Please provide any documentation regarding your child’s special needs that may help better equip us to make our determination. NOTE: This may include documents such as an IEP or similar analysis but is not required. We do NOT wish to receive any medical records.
Unlimited number of files can be uploaded to this field.
64 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
If your child has diabetes, asthma and or a seizure condition please indicate here so we can send the required emergency plan forms in advance:
Please note that the YMCA does not employ medically trained staff. (i.e., nurses) Our staff are trained in Pediatric CPR/AED and First Aid only. We do not administer medication outside of that needed in emergency situations such as Epi Pens and asthma inhalers. We cannot assist in the administration of insulin, or any medication administered by injection.
 
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