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St. Mary YMCA Early Learning Application Form

HTCSD and St. Mary School are pleased to continue our partnership with YMCA of Regina to offer an Early Learning Program in our school.

All applicants will be contacted by St. Mary administration for an interview before acceptance into the program is given.

Please complete the form below. Required fields marked with an asterisk *

Parent Name(s):*

Answer Required

Child's Name*

Answer Required

Child's Date of Birth (Day/Month/Year)*

Answer Required

Address:*

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Home Phone:*

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Cell Phone:

Answer Required

Parent email address*

Answer Required

Has your child ever been involved with any outside agencies? (ex: Speech, ECIP, etc)? If yes, please identify:*

Answer Required

Will your child be attending Kindergarten at St. Mary School? If no, please explain:*

Answer Required