Registration

Start your MAYC enrollment.

New families begin with the MAYC Membership Enrollment Form. Once membership information is submitted, MAYC staff can help with program availability, fees, and next steps.

Start enrollment Already a member?

Before You Begin

Membership comes first.

Children must be active MAYC members before registering for programs. The annual membership fee is $20.

Membership Enrollment

Tell us about your child.

Complete the form below for a new or renewing membership.

Already an active member?
Skip this form and use Family Help below for availability or registration questions.

Child's Name *

First

Last

Nickname

Date of Birth *

Gender *

Male
Female
Other

Race *

School *

Have you ever been enrolled in a MAYC program before? *

All Parents/Guardians Name *

All Parents/Guardians Email *

List all emails that would like to be included in announcements and updates

Home Address

Phone #1 *

Will be first number called in case of an emergency

Phone #2

Authorized Individuals *

Please list the names, phone numbers, and relationship for each person authorized to pick up your child. No child will be released to any individual not listed above or to any family or non-family member under the age of 18. Any additions, deletions, modifications or request to list any family member authorized to pick up a MAYC member must be submitted in writing by the parents and/or legal guardians. If you request that your child be able to sign themselves in and out from programs please contact programs@mahometyouth.org.

Youth and Family Information *

MAYC Collects and submits data to our funding and grant sources. Only the data is reported and no individual or family information is released. Pelase complete the following information when submitting this form.

Household - Family Size *

List complete family size

Household - Number of Children *

List the child's number of siblings

Household - Number of Adults *

List total number of adults in the household

I would like to apply for a scholarship. Daily fees vary. *

Parents/Guardians: If you are seeking reduced fees or a MAYC scholarship you will be required to provide proof of income. You are also required to report any changes in household size, financial assistance received, or income levels.

Does your child have a disability or IEP *

If yes, please describe in section below.

Please list any health issues, disabilities, allergies* and/or problems: *

If your child has a serious medical condition or allergy that requires special consideration or the administering of medicine, please fill out the Notice of Medical Condition Form. It can be found at the bottom of this page and elsewhere on our website, or you can stop by the office at 700 W. Main Street. *Please note that we are not a peanut free facility.*

Child's Doctor and Phone Number

Child's Medical Insurance Company:

Hospital Choice

Policy Number/Medicaid Number:

Emergency Contact #1 *

Please include name, relevant phone #s, and relationship. Parents/Guardians will be called before emergency contacts.

Emergency Contact #2

Please include name, relevant phone #s, and relationship. Parents/Guardians will be called before emergency contacts.

Name of person filling out this form. *

First

Last

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Family Help

Already a member or have a question?

Use this short form for program availability, registration questions, fees, scholarships, schedules, or next steps.