YMCA OF GREATER SEATTLE

Kids University Registration Form—Smith Elementary

CHILD’S INFORMATION

Legal First Name

MI Legal Last Name

School Attending Birthdate Grade Gender

Address City Zip Code

PRICING OPTIONS FACILITY MEMBER RATE COMMUNITY MEMBER RATE

□ By Class Sign-up for individual times and classes Payment is required in full with registration

Price Varies (see class selection for pricing)

□ Enrichment Pass Monthly Fee includes the choice of your class for each of

hours and days in the week (not including vendor classes) Does not include cost of Non-Student Days & Breaks

$470/month +

$50 Registration Fee

$525/month +

$50 Registration Fee

□ No School Days Non-Student Days & Breaks discounted price will be

available to Enrichment pass students

$270 for the School Year Or

$50 Per day

$360 for the School Year Or

$60 Per day

KIDS UNIVERSITY PROGRAM LOGISTICS & POLICIES

Classes take place at Smith Elementary between the hours of End of School-6:00pm on Monday-Friday.

Kids University provides multiple enrichment classes per hour block. Please select one class per hour block for enrichment pass and as few or as many classes as you would like per block for by-class.

Payment Information:

Enrichment Pass: Payment is automatically deducted on the 1st of the month for participation in that month’s program. Pay-ment will continue to deduct monthly until cancelled or the final payment on June 1st.

By Class: Payment is made in full prior to the start of each session.

The YMCA Kids University Enrichment Program follows the Lake Washington District Calendar.

Programs are offered on No School Days and Early Release Days. However participation on non-school days require additional registration and payment

Cancellation Policy: For withdrawal or cancellations, we require written notice 15 days prior to the participants end date. Failure to do so will make the payment non-refundable. Registration fee is non-refundable.

Financial assistance is available through the Y and you can find our financial assistance application online at www.ykids.org.

PARENT/ GUARDIAN CONTACT INFORMATION

Legal First Name Legal Last Name Birthdate Gender

Phone Number Email

Custom Questions 1. Is there a family situation you want us to be aware of that would affect who picks up your child? (If yes, we will follow up with you):

_____________________________________________________________________________________________________________________________________________________________________________________

2. Please indicate any health concerns or allergies that we need to be aware of. List NONE if not applicable to your child:

______________________________________________________________________________________________________________________________________________________________________________________

3. Lists any behavioral needs or concerns we should be aware of:

______________________________________________________________________________________________________________________________________________________________________________________

4. List any medications that need to be administered during program hours:

______________________________________________________________________________________________________________________________________________________________________________________

5. Please provide an emergency contact number (other than the number provided above): ______________________________________________________________________

SAMMAMISH COMMUNITY

831 228th Ave SE, Sammamish Washington 98075

P 425 391 4840 | sammamishymca.org

E

https://apm.activecommunities.com/seattleymca/Activity_Search?txtActivitySearch=53984%20|%2053981%20|%2053983%20|%2053982%20|%2053999https://apm.activecommunities.com/seattleymca/Activity_Search?txtActivitySearch=53979http://www.ykids.org

YMCA OF GREATER SEATTLE

Payment Authorization Form – Youth Enrichment Programs

PRIMARY MEMBER

Legal First Name MI Legal Last Name

Address Phone Number

PAYMENT AUTHORIZATION (Please select preference for payment method.)

Please charge my Electronic Funds Transfer on file. Type of account: Checking Savings

Please charge my Credit Card or Debit Card on file ending in _____ ____ _____ ____

I will log in to my Active account to enter Credit Card or Debit Card information before the 1st of the month. I

understand I will not be fully registered until this is provided.

Please contact me for payment information. I understand that I will not be fully registered until this is provided.

Please read and initial/sign below.

I understand that I will be charged on the 1st of the month my child attends. _______ initial

I understand that changes and cancelations need to be made in writing 30 days prior to each month to avoid being charged for the month. _______ initial

(DSHS Families Only) I Understand that my co-payment for care is due on the 25th of the month preceding care. _______ initial

I hereby authorize my financial institution to honor pre-

authorized debit entries by the YMCA on my account for YEP

payments and when my financial institution honors such debits by

charging my account this shall constitute my receipt for payment.

_________initial

I hereby authorize the YMCA to charge my credit card on a monthly basis for

payments as indicated above. When my financial institution honors such

debits by charging my account this shall constitute my receipt for payment.

_________initial

YMCA OF GREATER SEATTLE FINANCIAL POLICIES

I further stipulate the following conditions (please read and sign at the bottom):

I understand that the YMCA membership and programs are continuous and that monthly charges or debits, as indicated above, will continue until I give written notice to change or terminate the membership or program.

I understand any custody agreements involving division of program costs are solely between the legal parties involved and are outside the Payment Agreement made with the YMCA of Greater Seattle.

I understand that I must give the YMCA written notice (in person or by email ONLY) 30 days prior to the next scheduled draft to change or cancel my membership or program fees. Failure to do so will make the subsequent draft non-refundable. Any outstanding balances will be

due at the time of cancellation. I am liable for any fees that the YMCA may incur in its effort to collect any remaining balance due

I understand that I must inform the YMCA 14 days in advance of any changes to my name, address, telephone number or payment information. Failure to provide the YMCA with current information may result in non-refundable fees and that I am personally responsible

for any payments not processed by my financial institution and/or the YMCA

I understand that the YMCA will notify me at least 30 days in advance of any increase to my monthly membership dues or program fees.

I understand that it is my responsibility to bring any billing discrepancies to the YMCA’s attention within 60 days after they first appear on my financial statements. After 60 days, I waive my right to dispute such discrepancies.

I understand and authorize that NSF or collection of fees will be charged to me for any declined or returned monthly dues. Such non-sufficient fees will be the maximum amount allowed by law and will include applicable taxes.

Signed: ____________________________________________________________________________________________________________________________ Date: ________________________________

SAMANTHA SMITH KIDS UNIVERSITY REGISTRATION FORM Session 3: November 27 - February 14th , 2018

Child Name Grade Birthdate Gender

Monday Tuesday Wednesday Thursday Friday

Early Release 1:30pm-3:00pm

Chess4Life $196.00

or

Outdoor Survival

or

Kids Garden

or

Think Tank

Class 1 3:00pm-4:00pm

Fast Track Math $196.00

Speak Easy 1 - 5th

$196.00

Circus 101

Code Club: Programming Robots

3 - 5th $198.00

Gymnastics $183.00

or or or

Arts and Logic 1 - 5th

$185.00 Volleyball 101

Moana Small Hands on Art

Musical Theater $185.00

or or or

Leadership Sports of all Sorts Jurassic World

or or or or or

Rockwall String It Up Chess Club Dreamwork, Teamwork Artists Showcase

or or or or or

Math Games Wonders of World Dodgeball 2.0 Think Tank Think Tank

Class 2 4:00pm-5:00pm

Playground Games Lacrosse 3D Art Krafty Kids Parkour 1 - 5th

$193.00

or or or or or

Sewing Kinder fun Bunch Too Hot To Handle Diamond Dazzlers Candle Making

or or or or or

Think Tank Wednesday Walking Harry Potter

Boot Camp

Cardio Blast or

Football Friday

Class 3 5:00pm-6:00pm

Color Challenge Boot Camp Paper Folding No Bake Delights Lego Time

or or or or or

Write A Book Claymation Yoga Outdoor Games Winter Wonderland

By-Class Pricing - price is per session Enrichment pass participants will not pay the below, they will only be

charged the monthly fee.

Fees shown are for Facility Members of the YMCA. For Community Partici-pants, please add $15.00 additional per class.

Monday Tuesday Wednesday Thursday Friday

Early Release $188

Class 1 $100 $125 $125 $113 $113

Class2 $100 $125 $125 $113 $113

Class 3 $100 $125 $125 $113 $113

2017-18 Kids U Session Schedule By class participants will have to re-register and pay each session

Enrichment Plan Participants will not have to re-register each session but will get the opportunity to select new classes each session

Start End

Session 1 (Sampler) September 5 September 29

Session 2 October 2 November 22

Session 3 November 27 February 14

Session 4 February 20 April 27

Session 5 April 30 June 20

Email to: eastsidechildcare@seattleymca.org

VENDOR CLASSES

Arts and Logic

Arts And Logic is an interactive art program that will show kids what it takes to be an artist. We provide all the necessary art mate-rials for all students. Students explore drawing as realistic, creative and abstract representation of what they visually interpret as art. Students are ex-posed to examples that helps in the development of their artistic ability, and apply their learning to the goals and objectives of each lesson. This class builds skill, confidence and ability to express personal creative ideas through drawing, it also helps children devel-op their skill and imaginative ideas through the investigation of technique and style.

Chess4Life Chess Club

Code Club: Programming Robots

In this TechVenture Kids after school Code Club, we combine a real robot with coding to ignite children's imaginations! Coding projects are designed to build confidence in the way kids look at the world and approach problems. Students work together to pro-gram robots to deliver messages, navigate obstacles and more – developing their skills in reasoning, math, creativity and problem-solving in a fun, collaborative and supportive environment. This program is designed for students at multiple skill levels

Fast Track Math Fast Track Math offers an after-school math program using world-renowned Singapore Math, brain teasers, and math games. Stu-dents work on their math skills, tailored to their individual levels and abilities, in a fun and encouraging environment! Students work at their own pace and earn points that they redeem for prizes three times a year.

Gymnastics This is a class for beginning to intermediate girls and boys. We will teach skills on bars, beam, vaulting and in tumbling.

Moana Small Hands on Art: Musical Theater

Small Hands on Art is a not for profit organization that accepts all applicants and does not discriminate for any reason. We teach musical theater classes to children. All students signed up get a part. There is a recital for parents and friends on the last day.

Parkour This fun, high-energy class will provide the fundamentals include running, jumping, and climbing, and we build on these fundamen-tals to improve our ability to pass over, under, around and through obstacles with more complex movements.

Speak Easy Building leaders through public speaking

YMCA LED CLASSES 3D Art Make cool 3D projects using simple materials.

Artists Showcase Each week we will be exploring the art of different artists through their works and projects associated with their style. At the end of the session, the students will have created a portfolio of different art work styles!

Boot Camp Get up and get moving with boot camp! Each week students will learn about the importance of exercise and staying healthy!

Candle Making Dip candles, pouring candles, ice candles, and more! Learn how to make cool candles safely!

Cardio Blast Keep yourself active everyday! Explore a world of playground games you never knew existed. Each week we will learn two new and excitin games and try them out!

Chess Club Join Y staff as you learn and play the fun game of chess.

Circus 101 Come be part of the greatest show on earth! Learn all the different skills needed to be part of the circus and put on a circus at the end of the class!

Claymation Students will gain a basic understanding of clay as an artistic medium through various projects. Each week students will use clay and paints to create a new piece of art.

Color Challenge Students will be split into teams each week and will play games that challenge them to work together in order to win points for their team.

Diamond Dazzlers The course will be taching the basics of baseball/softball, from running to throwing to sliding and more.

Dodgeball 2.0 Enjoy a classic elementary school game while learning new variations to play with friends.

Dreamwork Teamwork Students will learn the value of teamwork by playing and completing a variety of games and activities

Football Friday Practice different kinds of football, and learn the practice! (Does NOT include tackle football).

Harry Potter Quidditch, potions, and more! Read, play, and learn like you would at Hogwarts!

Jurassic World Learn about the prehistoric period and all the creatures and plant life that existed before we walked the Earth! Sculpt, paint, and create your very own prehistoric terraninum!

Kids Garden Learn more about working outdoors and watching life grow.

Kinderfun Bunch Introduce K-2 to fun arts and crafts, educational games, and more!

Krafty Kids Kids will learn how to make fun and easy crafts that they take home!

Lacrosse Challenge your endurance and athletic finesse in this introductory course on lacrosse!

Leadership Leadership is a quality that few people possess naturally, but it's possible to boost your child's leadership abilities. Performing lead-ership activities in the group helps improve a childs self-esteem while teaching them to work well with others.

Lego Time With Legos, the limit is your imagination.

Math Games 1,2,3, games in this class will stress your knowledge and arithmetic in a fun laid back manner.

No Bake Delights Make it but no need to bake it! All recipes require zero oven use!

Outdoor Games Get outside and play! Learn new outdoor games to play with friends or in school!

Outdoor Survival Learn what to do if you go on hikes or camp, at the same time gaining environmental knowledge of the PNW!

YMCA LED CLASSES

Paper Folding Animals, flowers, hats, and boats oh my! There's so much that can be done by using some basic paper folding techniques!

Playground Games Playing outdoors is great- especially different playground games! This course will explore different games that can be played on the playground

Rockwall Learn the basics of bouldering and how to tie rock climbing knots in this beginners class of Rockwall!

Sewing Students will learn different terms relating to sewing and the skills for basic projects.

Sports of all Sorts Students will learn a new sport each week and join in the friendly competition!

String it Up Learn new ways to make bracelets and more with string!

Think Tank A class for you to practice your reading skills, get help with homework, and challenge your brain!

Too hot to Handle Discover new ways to use heat to make wonderful and unique works of art

Volleyball 101 Enjoy a classic winter sport with friends and Y staff!

Wednesday Walking Have you ever wondered how far you have walked during the course of a day? Participants will be learning about the benefits of walking and how to track how far they go

Winter Wonderland Make art work to bring home that will make your home feel like a winter wonderland!

Wonders of World A class for all young adventurers! Learn about the classic wonders of the world as you create mini replicas of each design.

Write a Book Bring your imagination to life in your very own book!

Yoga Learn how to calm down you spirit, mind, and body with some yoga practice!

Smith Session 3YGS Payment Authorization Form YEP.Fall.20161

School Attending: Birthdate: Grade: Gender: City: Zip Code: By Class: OffEnrichment Pass: OffNo School Days: OffLegal First Name_2: Legal Last Name_2: Birthdate_2: Gender_2: Email: Please indicate any health concerns or allergies that we need to be aware of List NONE if not applicable to your child: Lists any behavioral needs or concerns we should be aware of: List any medications that need to be administered during program hours: Please provide an emergency contact number other than the number provided above: undefined: Child Name: Grade_2: Birthdate_3: Gender_3: Check Box1: OffCheck Box2: OffCheck Box3: OffCheck Box4: OffCheck Box5: OffCheck Box6: OffCheck Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffCheck Box13: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffCheck Box17: OffCheck Box18: OffCheck Box19: OffCheck Box20: OffCheck Box21: OffCheck Box22: OffCheck Box23: OffCheck Box24: OffCheck Box25: OffCheck Box26: OffCheck Box27: OffCheck Box28: OffCheck Box29: OffCheck Box30: OffCheck Box31: OffCheck Box32: OffCheck Box33: OffCheck Box34: OffCheck Box35: OffCheck Box36: OffCheck Box37: OffCheck Box38: OffCheck Box39: OffCheck Box40: OffCheck Box41: OffCheck Box42: OffCheck Box43: OffCheck Box44: OffCheck Box45: OffCheck Box46: OffCheck Box47: OffCheck Box48: OffCheck Box49: OffCheck Box50: OffCheck Box51: OffMI: Address: Phone Number: undefined_2: Offundefined_3: Offundefined_4: undefined_5: understand I will not be fully registered until this is provided: Offundefined_7: Offinitial: initial_2: initial_3: initial_5: initial_4: Text1: Text2: Text4: Legal First Name: Legal Last Name: First: Last: M: undefined_6: Off