Priority (1-6)

Participant Initials

SENIOR SNEAKER TRIPS

Date

Time (approximate)

Fee

Rank Trip choices using “1” as first choice through 6 for last choice in the Priority Column

Whale Watching, Monterey Bay

Barcode: 29517 Thursday

January 10 7:45a.m.-5:00p.m.

R $76 NR $91

Steinbeck House, Salinas

Barcode: 29518 Tuesday

January 15 8:30 a.m.-5:30p.m.

R $70 NR $84

Wicked, Orpheum Theatre

Barcode: 29533 Thursday

January 24 11:00a.m.-5:30p.m.

R $115 NR $138

Norman Rockwell, Crocker Museum

Barcode: 29516 Saturday

February 2 10:30a.m.-5:00p.m.

R $50 NR $60

Sacred Places II Barcode: 29534

Wednesday Feb 20

11:00a.m.-6:30p.m. R $72

NR $86

Davies Symphony Hall, San Francisco

Barcode: 29519 Thursday

February 28 7:45a.m.-1:00p.m.

R $45 NR $54

Register (X)

Participant Initials SPECIAL EVENTS Date Time

(approximate) Fee

Mardi Gras Celebration

Barcode: 26991 Tuesday

February 12 4:00p.m.-6:00p.m.

R $7 NR $9

Evening With Ruthe Steine

Barcode: 26992 Wednesday February 20

6:30p.m.-8:30p.m. Free

Register (X)

Participant Initials BUZZ SESSIONS & OLLI Date Time

(approximate) Fee

Your Cane, Your Friend

Barcode: 29486 Tuesday

January 8 9:00a.m.-10:00a.m. Free

Give Yourself a Break

Barcode: 29487 Tuesday

January 15 10:00a.m.-11:00a.m. Free

What is so Pinteresting?

Barcode: 29488 Tuesday

January 22 9:30a.m.-10:30a.m. Free

Finding Your Family History

Barcode: 29489 Tuesday,

January 29 10:00a.m.-11:00a.m. Free

Five Ways To Hold Title

Barcode: 29490 Tuesday

February 5 9:30a.m.-11:00a.m. Free

Grocery Shopping With a Purpose

Barcode: 29491 Tuesday

February 12 10:00a.m.-11::00a..m. Free

TOTAL FEES Page 1 $

Registration Form—January/February 2013

Registration Dates: December 12(Residents) December 14 (Non-Residents)

INSTRUCTIONS: To register, check the Register box next to each activity in which you would like to participate and the initials of the person registering. For trips please rank your trip choice from 1 (most desired) to 6

(least desired). You will receive a receipt in the mail confirming that you have been registered for the activi-ties you selected. R = fee for Danville residents; NR = fee for non-residents.

NOTE: Information on refunds/cancellations/withdrawals and make-up classes are on page 4

Participant Initials BUZZ SESSIONS & OLLI (Cont.) Date Time

(approximate) Fee

Diabetes Management

Barcode: 29492 Tuesday,

February 19 9:30a.m.-10:30a.m.. Free

Are Your Ducks in Order?

Barcode: 29499 Tuesday

February 26 10:00a.m.-11:00a.m. Free

OLLI Lecture: Social Security for

Baby Boomers Barcode: 29484

Tuesday, January 15

1:30p.m.-3:00p.m. R $5

NR $6

OLLI Lecture: Mt. Diablo, Local Icon

Barcode: 29485 Tuesday

February 19 1:30p.m.-3:00p.m.

R $5 NR $6

Participant Initials CLASS/ACTIVITIES Date Time

(approximate) Fee

AARP Driving Safety Barcode: 29177

Thursday 1/17-1/24 9:00a.m.-1:00p.m. See Registration

info.

Basic Ballroom Dance Barcode: 29545

Wednesdays 1/2-2/27 11:45a.m.-12:35p.m. Free

Bombay Jam—Demo Barcode: 29584

Tuesday January 8 5:30p.m.-6:30p.m. Free

Bombay Jam Barcode: 29585

Tuesdays 1/15-2/26 5:30p.m.-6:30p.m. R$49

NR $58

Bridge Basics II Barcode: 29607

Wednesdays 1/9-2/27 10:00a.m.-12:00p.m. R $100

N $120

Cane Do Barcode: 28515

Tuesdays 1/8-2/26 9:00a.m.-10:00a.m.

R$65 NR $78

Chinese for Travelers Barcode: 29630

Saturdays 1/5-2/23 10:00a.m.-11:00a.m. R $40

NR $48

Cooking Demo: Chinese New Year Barcode: 29672

Friday January 18 12:00p.m.-1:00p.m.

R $3 NR $4

Dancercise Barcode: 29544

Wednesdays, 1/2-2/27 10:50a.m.-11:40a.m. Free

Gentle Stretch Barcode: 29560

Wednesdays 1/9-2/27 3:00p.m.-4:00p.m.

R $48 NR $57

Gluten Free Baking Barcode: 29673

Thursday January 24 1:00p.m.-4:00p.m. R $40

NR $48

Jackie Sorensen’s Aerobic Dancing Barcode: 29477

Monday 1/7-2/25 5:30p.m.-6:30p.m. R $30

NR $36

Jackie Sorensen’s Aerobic Dancing Barcode: 29478

Wednesday 1/9-2/27 5:30p.m.-6:30p.m. R $42

NR $50

Line Dance - Beginner/High Beginner Barcode: 29674

Thursdays 1/3-2/28 10:00a.m.-11:00a.m. R $24

NR $29

Line Dance - High Beginner/

Easy Intermediate Barcode: 29675

Thursdays 1/3-2/28 11:15a.m.-12:15p.m. R $24

NR $29

Lotions & Balms

Barcode:29683 Thursday

February 7 1:00p.m.-3:00p.m.

R $35 NR $42

TOTAL FEES Page 2 $

Participant Initials CLASSES/ACTIVITIES (cont.) Date Time

(approximate) Fee

Luk Tung Kuen Barcode: 29543

Wednesdays 1/2-2/27 10:00a.m.-10:40a.m. Free

Scrabble, Fun With Words Bar Code: 29588

Tuesdays 1/8-2/26 12:30p.m.-3:00p.m. Free

Senior Stretching

Barcode: 29566 Fridays

1/4-2/22 9:15a.m.-10:15a.m.

R $25 NR $30

Sit to Get Fit

Barcode: 29557 Mondays 1/7-2/25

9:00a.m.-10:00a.m. R $60

NR $72

Spanish Conversation

Barcode: 29579 Mondays

1/7/-2/25 11:00a.m.-12:30p.m

R $40 NR $48

Tai Chi Barcode: 29542

Wednesdays 1/2-2/27 9:00a.m. – 9:50a.m. Free

Tai Chi Chih and Qi Gong Barcode: 29680

Tuesdays 1/8-2/26 10:30a.m.-11:30a.m. Free

The Film Salon Barcode: 29475

Wednesdays 1/9-2/27 1:30p.m.-4:30p.m. R $40

NR $48

Ukulele

Barcode: 29586

Tuesdays 1/8-2/26

2:30p.m.-3:30p.m. R $80

NR $96

Writers Group Barcode: 29682

Tuesdays 1/8-2/26

5:30p.m.-6:30p.m. R $40

NR $48

Yoga Barcode: 29562

Mondays 1/7-2/25 11:00a..m.-12:15p.m. R $57

NR $68

Yoga Barcode: 29563

Mondays 1/7-2/25

12:30p.m.-1:45p.m. R $57

NR $68

Yoga Barcode: 29561

Wednesdays 1/9-2/27

8:15.m.-9:30.m. R $76

NR $91

Zumba - Mondays Barcode: 29480

Mondays 1/7-2/25

4:10p.m.-5:10p.m. R $42

NR $50

Zumba Gold - Thursdays Barcode: 29481

Thursdays 1/10-2/28

5:30p.m.-6:30p.m. R $56

NR $67

Welcome to Medicare

Barcodes: 29637 Saturday

January 12 10:00a. .m.– 12:30p.m.

Free

Welcome to Medicare

Barcodes: 29638 Saturday,

February 9 10:00 a .m.– 12:30 p.m. Free

FEES

TOTAL FEES Page 1 $

TOTAL FEES Page 2 $

TOTAL FEES Page 3 $

TOTAL FEES $

Senior Services Sub-committee Meeting Wednesday, January 23, 2013 at 4:00 p.m.

REGISTRATION INFORMATION

Mail or drop off your registration form to the Danville Senior Center or the Danville Community Center. All resi-dent registrations received by December 11 at 5:00p.m. will be processed beginning Wednesday, December 12, with no priority given. Non-resident registration will begin on Friday, December 14. Phone and walk-in registra-tion will begin on Monday, December 19. To register by phone, please contact the Danville Senior Center (925)314-3490. Senior Sneaker trips will meet at the Danville Park and Ride lot. Please note times listed for each Senior Sneaker trip are approximate. Staff will mail out a detailed checklist approximately one week before the trip with exact meeting time. Class Cancellation/Withdrawals Requests for withdrawal will be honored if requested no later than 5 business days prior to the first day of class. Requests made less than 5 business days prior to the first day of class must be submitted in writing and will be considered on an individual basis. A $20 processing fee will be charged for processing refunds. Make-up Classes Whenever possible, make-up classes will be given on those occasions when inclement weather or instructor ill-ness requires that a class be cancelled. No refunds (whole or partial) can be given for classes missed by the stu-dent. Senior Sneaker Trip Refund Policy: When registration falls below the minimum enrollment required, it may be necessary to cancel a trip. At the time of cancellation, the Town will initiate a full refund. Please allow 3 to 4 weeks for refunds to be processed. Withdrawal and refund requests must be submitted five working days prior to the trip. You may elect to receive a full credit on your account or a refund with a $20 cancellation fee. Refunds will not be given for trips designated (no refund). Senior Sneaker Trip Registration Priority: Due to the high demand of the Senior Sneaker program, seniors will be limited to registering for two trips per month, or a total of four per issue of the Silver Streak newsletter. When choosing your trips, please number them in order of priority. In Case of Emergency: Please call Senior Services to verify that your emergency contact information is current. Since prompt medical care is crucial in an emergency, the Town would like to ensure we have the most current information for each participant. If you wish to register by mail, complete the form and mail with payment to:

Danville Senior Center Attn: Class Registrations 115 E. Prospect Avenue

Danville, CA 94526

Checks payable to “Town of Danville” (Circle One): Check Cash (exact amount) MasterCard Visa AMEX

Name (s): ____________________________________________________________________________________________________________________________

Address/City___________________________________________________________________________________________________Zip:_____________________

E-Mail Address: ____________________________________________Home Phone: ____________________Cell Phone: _________________________

Credit Card No: ____________________________________________Exp. Date: ____________ Signature: ______________________________________