2020/2021 - YDASH REGISTRATION FORM | Manatee YMCA Manatee YMCA

Please fill out the following registration form to reserve your spot for the 2020/2021 YDASH Program:

YDASH 2020/2021 Registration

Student - First Name *

Student - Last Name *

Gender

Female

Male

Birth-date (Day/Month/Year) *

Which school does your teen attend? (Please select one) *

Address

City

State/Province

Address

Who does the child live with? *

1. Parent/Guardian's Name *

Email (This email will be used for e-billing and YDASH information) *

Phone *

2. Parent/Guardian's Name

Phone

Select your payment option *

Bank Draft/ACH ($65/per month)

Check/Money Mail Order ($75/per month)

If you have any questions, please contact Rhiannon Blaney at rblaney@manateeymca.org. Once you submit the registration form, you will be emailed additional paperwork to complete and all billing information.

Thank you!