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 session 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 4: February 20 - April 27, 2018

Child Name Grade Birthdate Gender

Monday Tuesday Wednesday Thursday Friday

Early Release 1:30pm-3:00pm

Chess4Life $178.00

or

Origami Masters

or

Tag It, Run It

or

Think Tank

Class 1 3:00pm-4:00pm

Arts and Logic $185.00

Game Development Beginner/Intermediate

3rd - 5th $217.00

Boot Camp

Speak Easy 1st - 5th $178.00

Small Hands on Art The Pirate Play

$152.00

or or or

Fast Track Math $196.00

Group Games

Parkour 1st - 5th $173.00

or or or

Challenge Accepted Outdoor Games Gym Time 2

or or or or or

Dodgeball Weird Science Field Fun Dodgeball Smart Art

or or or or or

Think Tank Think Tank Felt Art Bedazzling Beads Think Tank

Class 2 4:00pm-5:00pm

Disney Mania Washington Wildlife STEM Challenge Got Hops?

Gymnastics $164.00

or

Nature Crafts

or or or or or

Brainy Builders Lego Time Holidays Around The

World Think Tank Slime Time

Class 3 5:00pm-6:00pm

Reading Corner Parachute Games Board Games Boot Camp Crazy Cards

or or or or or

Yoga Thrifty Gifts Rockwall Tasty Treats Soccer

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 $169

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

Class2 $100 $113 $113 $113 $100

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

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 ses-sion 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

YMCA LED 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 an opportunity for your kids to explore the wonderful world of art. We provide all the necessary art materials for all students. We start-ed the year with the elements of art, the visual tools artists use to create art work. We are going to use these elements and study them with artist’s work. Kids will manipulate these elements, mix them with the principles of design, com-pose and explore the wonderful world of art inspired by famous artists. Grades K-5th

Chess4Life Chess Club. Grades K-5th

Fast Track Math

Fast Track Math offers an after-school math program using world-renowned Singapore Math, brain teasers, and math games. Students work on their math skills, tailored to their individual levels and abilities, in a fun and encouraging envi-ronment! Students work at their own pace and earn points that they redeem for prizes three times a year. There is an additional one time only $25 material fee to be paid directly to the vendor. Grades K-5th

Game Development: Beginner/Intermediate

This course introduces kids to computer programming through the fun and excitement of building video games. Work-ing in Scratch, a drag-and-drop programming tool, students will create everything from animations to multi-level games. Beginner Students will learn the core concepts of programming a game, such as loops, conditionals, and variables. Inter-mediate Students will level-up to more complex concepts, like nested conditionals and functions with parameters. Pro-jects are updated each session, so returning students will have new challenges to work through and advance their crea-tivity and knowledge to the next level. Grades 3rd - 5th

Gymnastics This is a class for beginning to intermediate girls and boys. We will teach skills on bars, beam, vaulting and in tumbling. Grades K-5th

Parkour This fun, high-energy class will provide the fundamentals include running, jumping, and climbing, and we build on these fundamentals to improve our ability to pass over, under, around and through obstacles with more complex movements. Grades 1st-5th

Small Hands on Art: The Pirate Play a Swashbuckling Melodrama and Around the World Games Class

This is a Pirate Play, a swashbuckling Melodrama, with original music, and funny lines. Come join the fun with Small Hands on Art, Howie and Amy McOmber. Also included in April is an Around the World Games class. This is a melodra-ma put on my Howie and Amy McOmber. Everyone who comes gets a part. It is fun, full of pirates, ladies, it is funny, and creative. We provide sets and costumes, and you will love to see your child up on stage, overcoming the fear of being in front of others, and performing with confidence. Come join the fun! The Around the World Games class in-cludes fun games that were invented before video screens were around. Your child will have a great time in this class. Amy McOmber started teaching a class like this 24 years ago, and it is still as much fun today as it was then. Very ac-tive, creative, and something they will take with them the rest of their lives. Grades K-5th

Speak Easy Public Speaking and Leadership. Grades 1st-5th

Bedazzling Beads Develop your fine motor skills and learn how to make unique works of art that are also wearable.

Board Games Learn strategy and patience as you play various board games with and against your friends.

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

Brainy Builders Use different materials to build new challenges each week.

Challenge Accepted Work individually and in groups to solve and create new challenges!

Crazy Cards Learn new card games to challenge your friends and family each week.

Disney Mania Do you love Disney movies? Talk about your favorite movies and characters as you make fun crafts!

Dodgeball Enjoy a classic elementary school game while learning new variations to play with ends!

Felt art Learn how to use felt for a variety of projects including lollipops, pillows, and more!

Field fun Get outside and on the field to play fun games including kickball, world cup and more.

Got Hops? Ants in your pants? Have a lot of energy? Jump around with Y staff and your peers in this course!

Group Games It's time to have fun working together as a group, lead games as a group to successfully play a variety of different games that challenge you, get your heart rate up, and have a good ol' time together.

Gym Time 2 Spend time in the gym learning new games and playing some great classics with a twist!

Holidays around the World Learn about holidays from different countries through arts and crafts.

Lego Time With Legos, the only limit is your imagination. Challenge yourself to build new creations each week!

Nature Crafts Each week children will create works of art to take home using items related to nature to develop an appreciation for the world around them, as well as inspire their creativity.

Origami Masters It's all about Paper folding. From Balloons to boxes, cranes to frogs, we'll do it all! Create Some fantastic pieces to take home each day.

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

Parachute Games Playing around with a parachute and seeing how many games can be played, running under, over, or around.

Reading Corner Come relax and read while building reading skills and vocabulary.

Rockwall Explore the Rockwall, discuss safety and test your climbing ability.

YMCA LED CLASSES

Slime Time Explore different states of matter as you make messy projects each week.

Smart Art Explore the world of mathematics through different art projects!

Soccer Its the most popular sport in the world, so lets practice some basics. Getting skills down to play endless games and score on the other team.

STEM Challenge like to build and create things? Each week you will work in a team to build and construct different challenges and solve problems to complete tasks.

Tag It Run It Students will learn different tag games and learn different skills and techniques.

Tasty Treats Bake tasty treats to take home and share with your family and ends!!

Think Tank Expand your brain and challenge yourself each week by solving riddles, Sudoku, mazes, puzzles, crosswords, hidden pictures and much more as well as a time for them to do their homework.

Thrifty Gifts Create Heartfelt, handmade gifts that are great for any occasion.

Washington Wildlife want to learn more about the wildlife that lives in our own state? This course will help you explore Washington’s wilderness by learning about animals and plants that are right outside our homes. Each kid will create a handmade book filled with Washington wildlife activities and crafts.

Weird Science Use science to make gross and weird creations!

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

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