Thank you for your interest in the Y Safety Around Water program. If you are new to the Y, please create a new account. Otherwise, complete the information below for all participants. Note: Do not create a new account if you’ve used Y programming in the past. Call us at 612-230-9622, if you are unsure.

* All fields required unless otherwise noted

Enter Parent Information


Parent Date of Birth

Is your child on a free reduced school lunch?
How many people live in your household?
What is your household income?

Enter Participant Information

Participant 1 Date of Birth

Participant 1 Gender
Participant 1 Ethnicity

Add up to 3 additional optional participants below. If you need to add more than 3, please submit the form again with the additional participant information.

Participant 2 Date of Birth

Participant 2 Gender
Participant 2 Ethnicity

Participant 3 Date of Birth

Participant 3 Gender
Participant 3 Ethnicity

Participant 4 Date of Birth

Participant 4 Gender
Participant 4 Ethnicity