Martinsville-Henry County Family Ymca 2015-2016 School Year Form (Page 5 of 7) in pdf

Martinsville-Henry County Family Ymca 2015-2016 School Year Form Page 5

Office Use ONLY

Identity Verification

If proof of identity is required and a copy is not kept, please fill out the following:

Date of notification of Local Law-Enforcement Agency

(when required proof of identity is not provided):

Place of Birth & Birth Date:

Birth Certificate Number:

Date Issued:

Other Form of Proof:

Date Documentation Viewed:

Person Viewing Documentation:

Proof of child’s identity and age may include a certified copy of the child’s birth certificate, birth

registration card, notification of birth (hospital, physician, or midwife record), passport, copy of the

placement agreement or other proof of the child’s identity for a child placing agency (foster care and

adoption agencies), record from a public school in Virginia, certification by a principal or his designee of

a public school in the U.S. that a certified copy of the child’s birth record was previously presented or

child’s proof of identity is not necessary when the child attends a public school in Virginia and the

center assumes responsibility for the child directly from the school (i.e., after school program) or the

center transfer responsibility of the child directly to the school (i.e., before school program). While

programs are not required to keep the proof of the child’s identity, documentation or viewing this

information must be maintained for each child.

Martinsville-Henry County Family Ymca 2015-2016 School Year Form Page 5