Kids' Time Schedule Change Form

This form is to be used if you need to request time off for your child from Kids' Time, or if you are withdrawing your child from the program permanently.

As a registered participant in the YMCA Kids’ Time program, I understand that I must give at least 10 days notice of my child’s absence from the program in order not to be charged for that day/week. I understand that if I do not give at least a week’s notice by completing this form, I will be charged in full for that day/week.

This form does not apply for any planned holiday or special occasion breaks throughout the school year per the school district calendar.

We may need to call you to confirm changes.
List dates you are withdrawing child. Write permanent if you are fully withdrawing child.
Must be approved by YMCA office.

If you have further questions:


Rockford Schools, contact Peter Shipp at pshipp@rockriverymca.org.

Harlem & Pecatonica Schools, contact Becca Homb at bhomb@rockriverymca.org.