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* 1. If an after school program facilitated by the Clinton YMCA was held at Schneider Elementary for grades K-5 starting on January 5 from 2:20-5:45 p.m. Tuesday-Friday, would you be interested in sending your child/children at the cost of $12.50 for each child per day.

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* 2. Which days would you be interested in sending your child/children? Please check all that apply:

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* 3. How many children would you send to Y-Zone in grades K-5:

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* 4. What grades are your children enrolled in that would be attending? Please check all that apply:

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