Essential Worker Verification Form

Complete this form to submit your verification for essential worker care. All fields are required. Applicants must register for YMCA Child Care prior to submitting this form.

1 Start 2 Page Break 3 Complete

Parent Information

Full Name of Parent

First Name *

Last Name *

Parent Email *

Employer Information

Name of Employer *

Employer Address

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Employer Phone Number *

Position *

Employer Email

Employment Verification

Employment Verification Method *

Upload Verification Documentation *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png html pdf doc.

Residency Verification

Residency Verification Method *

Proof of Residency *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png html pdf doc.

Name(s) of Child(ren) and Date(s) of Birth

Child 1

First Name *

Last Name *

Date of Birth *

Month

Day

Year

Child 2

First Name

Last Name

Date of Birth

Month

Day

Year

Child 3

First Name

Last Name

Date of Birth

Month

Day

Year

Child 4

First Name

Last Name

Date of Birth

Month

Day

Year

Leave this field blank

Athens-McMinn Family YMCA

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Athens-McMinn Family YMCA

Essential Worker Verification Form

You are here

Mission Statement

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