School Age Child Care Waiting List

YWCA Elgin has offered high-quality, affordable child care to children in kindergarten through fifth grade at an affordable price for over 50 years. Our program is full at the moment, but completing this form will add them to our waiting list. Our Youth Services Director will call you when a spot becomes available. Please be patient.

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Parent/Guardian's Information

First Name Last Name

Street Address (Optional)

Postal Code City State

Email Mobile Phone

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(Optional)

Information About Child Needing Care

How much money do you make in one year, before taxes?

1st Child's Name

1st Child's Age

1st Child's School

1st Child's Grade in School

2nd Child's Name (if applicable) (Optional)

2nd Child's Age (if applicable) (Optional)

2nd Child's School (if applicable) (Optional)

2nd Child's Grade in School (if applicable) (Optional)

Other Circumstances (Optional)