YMCA OF GREATER TORONTO

Licensed Home Child Care
Change Request Form

To make changes to your child’s registration, edit your contact information, or submit a program withdrawal notice, complete the form. Please note, updates and changes can take up to 10 business days to be completed.

Parent/Guardian Name

First Name

Last Name

Child's Name

First Name

Last Name

Licensed Home Child Care Location

Phone Number on File

Type of Change

Registration Change

Please note that registration changes require 10 business days notice.

Select the date you want the changes to be implemented

Indicate Type of Change Required

Other Notes/Details

Withdrawal

Reminder: The YMCA requires 10 business days' notice of withdrawal. Accounts will be charged for the two-week notice period if the withdrawal date given is less than two weeks from the last day of care indicated.

Select the date for your child(ren's) last day of care.

Are you receiving Municipal Child Care Subsidy

YesNo

Parent/Guardian Contact Information

Parent/Guardian 1

First Name

Last Name

Home Phone Number

Cell Phone Number

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Business Name

Business Phone Number

Business Email

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Parent/Guardian 2

First Name

Last Name

Home Phone Number

Cell Phone Number

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Business Name

Business Phone Number

Business Email

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Other notes/details

Emergency Contact Information

Emergency Contact 1

First Name

Last Name

Home Phone Number

Cell Phone Number

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Business Name

Business Phone Number

Business Email

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Emergency Contact 2

First Name

Last Name

Home Phone Number

Cell Phone Number

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Business Name

Business Phone Number

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Other notes/details

Medical/Allergy update

Allergy Notes/Details

Payment Information Change

Please note: Submitting this form does not complete a Payment Information Change. To finalize your change, fill out the Preauthorized Payment Form which will be sent to you via DocuSign. Please ensure DocuSign is included in your account’s safe sender list.

Select the date you want the changes to be implemented

Indicate Type of Change Required

%message%

Thank You!

Please allow up to 3 business days for your request to be processed.