Provider ID Authorization Number Amount Transferred Child 1 Amount to be applied to this child's account Child 2 Amount to be applied to this child's account Child 3 Amount to be applied to this child's account Parent/Guardian Name Parent/Guardian Email Address Account credited upon receipt/validation of this form. Late fees may apply. Parents/guardians are responsible for fees and/or balance(s) due not covered by DCF. ALL FEES as outlined in our policies, must be paid before children can attend/participate in services. Overpayment may result in direct refund to DCF. For questions regarding your account or balance due, please contact the YMCA Child Care Accounts Office at childcare@ymcawichita.org.