Account Change Requests

This form is to be used if you need to make changes to your Kids’ Time account or child information. Only the primary adult on your account is permitted to request changes to the account. Please allow 2-3 business days for any change requests to be made.

Please note: Emergency & Authorized Pick-Ups must be 18 years of age or older. YMCA staff will request to see a valid ID or Driver’s License prior to releasing your child from the program. If there are any safety concerns that you would like YMCA staff to be aware of (i.e.- an order of protection), please email us at kt@rockriverymca.org.

For any additional questions, please email us at kt@rockriverymca.org

Child's Enrolled Name:
Child's Date of Birth:	Date and timeToday
Parent/Guardian Name:
Guardian Email:
Guardian Phone Number:	We may need to call you to confirm changes.
School:
What type of change would you like to make to your Kids’ Time account?:
Schedule Change: please state in detail the change you are requesting. (include the dates you are requesting to add or remove from your child’s registrations):
Add or Remove an Emergency & Authorized Pick-Up: please include the adult's full name, their phone number(s), and their relationship to your child. :
Additional comments or changes:

Account Change Requests

If you have further questions, please contact our team at kt@rockriverymca.org.