Toddler Summer Camp Forms

For Registered Families

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Toddler Summer Camp Forms

Families registered for Summer 2018 must complete and submit the Child Information Form and the Health Form by June 8, 2018.

You can download the Health Form via the button below.

Download Health Form

Completed Health Forms should be submitted to Julia Massey, Assistant Director of the Parenting Center, via email at JMassey@14streety.org, or hand delivered to the Service Desk in our lobby.

If you’d like to mail the form, please send it to:

14th Street Y
344 East 14th Street
New York, NY 10003
Attention: Julia Massey

In addition, please fill out the Child Information Form below:

Toddler Camp Child Information Form

To prepare for the start of Toddler Camp, please complete this form to ensure we have this important information on record.

Child's Name*
First Last
Child's Date of Birth*
MM slash DD slash YYYY
Parent 1*
First Last
Parent 1 Email*
Parent 1 Cell #*
Enter without dashes or parenthesis
Parent 2
First Last
Parent 2 Email
Parent 2 Cell #
Enter without dashes or parenthesis
Sitter's Name
First Last
If applicable
Sitter's Cell#
Enter without dashes or parenthesis
Emergency Contact Name / Relationship*
Emergency Contact Phone #*
Enter without dashes or parenthesis
Doctor's Name / Clinic*

Please provide the name and location of your doctor.
Doctor's Phone #*
Enter without dashes or parenthesis
Who is bringing/picking up your child to/from class?
Name of person bringing/picking up child to/from class*
Relationship to child?*
What day(s) is this person bringing or picking up your child?*
Name of additional person bringing/picking up your child to/from class*

*If applicable
Relationship to child?
What day(s) is this person bringing or picking up your child?
Other Important Information About Your Child
Does your child have any allergies? If exposed to the allergen(s), is medication required?
Is your child on any medication? If yes, are there any side effects we should know about?
Please briefly update us on your child’s favorite activities, energy level, behavior in social interactions, physical and language development:*
Does your child have any physical or developmental challenges we should be aware of?
Is there anything else we should know?
CAPTCHA

The more information we have about your child’s physical and developmental profile, the better we can serve his/her needs. All information is kept confidential.

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Toddler Summer Camp Forms

For Registered Families

Toddler Summer Camp Forms

In addition, please fill out the Child Information Form below:

Toddler Camp Child Information Form

Who is bringing/picking up your child to/from class?

Other Important Information About Your Child