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AMILIA Activation
About
Adult Center
Aquatics
Camp
Children & Family
Fitness Wellness
Food Pantry
Jewish Life
Support Services
Adler Center
“Y” Volunteer
- Volunteer Opportunities

Aquatic Group Lesson Make-up Request – Form

Aquatic Group Lesson Make-up Request – Formjoyadmin2025-10-14T12:53:39-04:00

Aquatic Group Lesson Make-Up Request

We allow one make-up each session for missed class due to a medical reason.

Child's Name *

Parent's Name *

Email *

Phone *

Class Registered For: *

Day Of Class *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Time Of Class *

Date Of Missed Class *

Reason *

Upload Dr’s note *

Maximum file size: 268.44MB

If you are human, leave this field blank.

© 2026 Mid-Island Y JCC. All rights reserved. Mid-Island Y JCC • 45 Manetto Hill Road • Plainview, NY 11803 • Email: [email protected]

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Name *

First

Last *

Last

Phone

Email *

Party Date

Party Time

Number of People

Type of Party

Any Additional Information

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Party Central

Name *

First

Last *

Last

Phone

Email *

Age of Child

Party Date

Party Time

Type of Party You Are Interested in Type of Party You Are Interested in

Any Additional Information *

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Personal Training

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Personal Training

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Day & Time You Want to Train *

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