"Army Child, Youth & School Services Parent Central Services Office Registration Checklist Template"

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Army Child, Youth & School Services (CYSS)
Parent Central Services Office Registration Checklist
To expedite the registration process, please have the following information available.
ITEMS/INFORMATION TO BRING TO YOUR REGISTRATION APPOINTMENT:
Sponsor’s Social Security Number (Required by Army CYSS Fee Policy)
Proof of Eligibility (Military ID, CAC ID Card, Border Patrol Badges or Legal Guardianship papers)
Sponsor Home Information:
Full Name: ______________________________________________________________________
Home Address: __________________________________________________________________
Home Phone: ___________________________ Cell Phone: _____________________________
Sponsor Duty Information:
Active Duty Unit/Office Location: ____________________________ Rank: ___________________
Duty Phone: _______________________ Duty Email: ___________________________________
Spouse Work Information (if applicable):
Full Name: ______________________________________________________________________
Office Location: ________________________________ Office Phone: ______________________
Email: ________________________________________ Cell Phone: ________________________
Email Address (Any additional private email addresses that are checked regularly):
_______________________________________________________________________________
Proof of Household Income (LES/Pay Statements/ If spouse is full-time student, bring proof of school
enrollment)
Local Emergency and Child Release Designees – Minimum of 2 local contacts outside the home
Family Care Plan - DA 5305 (required for single/dual military families due within 30 days)
th
Child’s Official Shot Records (required for children under 6
grade in child care program)
Deployment Orders, if applicable
FORMS TO BE COMPLETED BEFORE YOUR APPOINTMENT:
Child Health Assessment/Sports Physical (Due within 30 days or before participation in any sports activities)
USDA Income Eligibility Form (Allows CYSS to receive additional funding to support meals/snacks provided)
Health Screening Tool (to evaluate overall health of child)
Medical Action Plan (MAP)
o Respiratory Action Plan – if child has asthma, reactive airway disease, or breathing problems.
o Allergy Medical Action Plan – if child requires any rescue medications (Benadryl, albuterol, EpiPen)
o Diabetes Medical Action Plan
o Seizure Medical Action Plan
o Special Diet Statement – if child has food allergies, food intolerance, or dietary religious restrictions.
CYSS Waivers (Transportation, Internet/Media Agreement, CYB-MFLC)
Registrations are by APPOINTMENT ONLY
PLEASE CONTACT PARENT CENTRAL SERVICES FOR APPOINTMENTS AT (520) 533-0738
Hours of Operation: 0700 – 1800 Monday through Friday
Army Child, Youth & School Services (CYSS)
Parent Central Services Office Registration Checklist
To expedite the registration process, please have the following information available.
ITEMS/INFORMATION TO BRING TO YOUR REGISTRATION APPOINTMENT:
Sponsor’s Social Security Number (Required by Army CYSS Fee Policy)
Proof of Eligibility (Military ID, CAC ID Card, Border Patrol Badges or Legal Guardianship papers)
Sponsor Home Information:
Full Name: ______________________________________________________________________
Home Address: __________________________________________________________________
Home Phone: ___________________________ Cell Phone: _____________________________
Sponsor Duty Information:
Active Duty Unit/Office Location: ____________________________ Rank: ___________________
Duty Phone: _______________________ Duty Email: ___________________________________
Spouse Work Information (if applicable):
Full Name: ______________________________________________________________________
Office Location: ________________________________ Office Phone: ______________________
Email: ________________________________________ Cell Phone: ________________________
Email Address (Any additional private email addresses that are checked regularly):
_______________________________________________________________________________
Proof of Household Income (LES/Pay Statements/ If spouse is full-time student, bring proof of school
enrollment)
Local Emergency and Child Release Designees – Minimum of 2 local contacts outside the home
Family Care Plan - DA 5305 (required for single/dual military families due within 30 days)
th
Child’s Official Shot Records (required for children under 6
grade in child care program)
Deployment Orders, if applicable
FORMS TO BE COMPLETED BEFORE YOUR APPOINTMENT:
Child Health Assessment/Sports Physical (Due within 30 days or before participation in any sports activities)
USDA Income Eligibility Form (Allows CYSS to receive additional funding to support meals/snacks provided)
Health Screening Tool (to evaluate overall health of child)
Medical Action Plan (MAP)
o Respiratory Action Plan – if child has asthma, reactive airway disease, or breathing problems.
o Allergy Medical Action Plan – if child requires any rescue medications (Benadryl, albuterol, EpiPen)
o Diabetes Medical Action Plan
o Seizure Medical Action Plan
o Special Diet Statement – if child has food allergies, food intolerance, or dietary religious restrictions.
CYSS Waivers (Transportation, Internet/Media Agreement, CYB-MFLC)
Registrations are by APPOINTMENT ONLY
PLEASE CONTACT PARENT CENTRAL SERVICES FOR APPOINTMENTS AT (520) 533-0738
Hours of Operation: 0700 – 1800 Monday through Friday
The following types of pay are included in the Total Family Income:
 Active Duty Pay
 Assignment Incentive Pay
 Basic Allowance for Subsistence (BAS)
 Basic Allowance Housing (BAH)
 Civilian Housing Allowance (LQA)
 Command Responsibility
 Foreign Language Proficiency
 Jump Pay
 Locality Pay
 Long Term Disability
 Medical Personnel
 Other Pension
 Premium Pay
 Retirement
 Special Duty Pay (Flight, Active Duty Demo, Sea, Submarine, Nuclear, Diving)
 Social Security (including SSI-Supplemental Security Income, SSDI-Social Security
Disability Income) Paid on Behalf of the Adult
 Surviving Spouse Benefits
 Tips
 VA Payments to Surviving Spouse
 Voluntary Salary Deferrals
 Wages and Salary
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