Westford Partnership for Children After School Enrichment Program NABNASSET SCHOOL SESSION 4: February 29-April 29, 2016

Child’s Name: _____________________________________ Teacher’s Name:_____________________ Grade:______ Best # to Reach:____________________ Name at this #:_____________________ Participation in the WPC program(s) may involve some risk of personal injury. I hereby release and covenant to hold harmless the Recreation Dept., its agents and employees from any and all actions, claims and damages for personal injuries that my child(ren) may have sustained and/or may have incurred as a result of participation in the program(s) for the 2015-2016 school year.

I, _____________________________________ (Parent/Guardian), agree to the above disclosure and have read and understand the WPC Policies listed in the Parent Handbook. Signature:____________________________________Date:______________

FIRST TIME SIGNING UP FOR THE 2015-2016 SCHOOL YEAR? PLEASE FILL OUT ALL OF THE FOLLOWING INFORMATION. FOR RETURNING PARTICIPANTS OF 2015-2016, IF ANY INFORMATION HAS CHANGED, PLEASE UPDATE BELOW.

DOB:____________________ Age:____________ M/F:_________ Allergies/Medical Concerns:________________________________________________________________________________Carries EpiPen®? Y N

Home Address:____________________________________________________________________ Home Phone: ________________________________________ Email: _______________________________________________________

Guardian Name: _________________________________________________ Relationship to Child: ______________________________ Work #: ______________________________ Cell #:_________________________________

Guardian Name: _________________________________________________ Relationship to Child: ______________________________ Work #: ______________________________ Cell #:_________________________________

Alternate Emergency Contact: ________________________________________ Relationship to Child: _____________________________ Home #:____________________________ Cell #:_____________________________

Each Block is $11 Mondays (8) Tuesdays (8) Wednesdays (8) Thursdays (7) Fridays (7) Session Total

Block 1: 3:10-4:00 Includes Snack

Circle one

Homework Homework Homework Homework

TGIF!

Enroll full time (Mon-Fri until 5:45 p.m.) and pay only

$1000/session. If using credit/debit card, pay either full

amount or $500/month.

Credit/debit card payments & Annual Enrollments must

submit WPC Charge Card Authorization

Form.

Free Gym

EFK : Aerospace (add $145; limit 12) Free Gym

Creation Station: Robotics (add $145; limit 10)

Free Gym Free Gym

Block 2: 4:00-5:00 Please circle which activity you would like your child to

participate in

Sports Sports Sports Creative Corner TGIF! Thank goodness it’s

Friday! Choice activities include crafts, sports &

games, educational programming, & more!

Outdoor Fun Computer Lab (Limit 10) Marvelous Mammals

General Art Homework General Art Basketball

Block 3: 5:00-5:45

Free Choice Free Choice Free Choice Free Choice TGIF!

Multiply $11 by # of blocks child is

attending

Daily Total:$__________

Daily Total:$__________

Daily Total:$__________

Daily Total:$__________

Daily Total:$__________

Multiply daily totals by # of days

Subtotal (Daily Total X 8):

$__________________

Subtotal (Daily Total X 8):

$__________________

Subtotal (Daily Total X 8):

$__________________

Subtotal (Daily Total X 7):

$__________________

Subtotal (Daily Total X 7):

$__________________

Block Total:

$ ___________

10% Sibling Discount part time only

-____________

Activity/Late Fee(s) +_______

TOTAL DUE: $____________

For Office Use Only: COPIED

Date Rec’d:______/________ Rec’d:_______:_______ a.m. p.m.

Rec’d By:____________________ from _________________________

Processed By:___________________ on_________/__________

Notes:

METHOD OF PAYMENT

Check: Payable to “Town of Westford”- CK#______________ Cash

Credit/Debit Card (Rec. Dept. must have WPC Charge Card Authorization Form on file) - Please check the appropriate box below:

Pay the full amount now Pay two equal installments *Activity/late fees are included in 1st payment Annual Enrollment

Signature: ___________________________________________________________________________________________ Date: _______________________________________

Start Date: _____________________

Forms released on February 8, 2016

Westford Parks & Recreation PO Box 2444

35 Town Farm Road Westford, MA 01886

P: 978-692-5532; F: 978-392-4471 www.westfordrec.com

Westford Partnership for Children After School Enrichment Program

Nabnasset School Session 4: February 29-April 29, 2016

ACTIVITY DESCRIPTIONS Marvelous Mammals: Learn about mammals & their habitats through different media. Basketball: Learn the basics of basketball & play a game. General Art & Creative Corner: Create simple art projects using various mediums. Time to get creative! Engineering For Kids: Jr. Aerospace Engineering (add $145,limit 12; 3:30pm-4:30pm): An introduction to the fundamental concepts of aircraft & spacecraft design; explore & construct airplanes, rockets, hot air balloons, & more! Creation Station: Jr. Robotics w/ Spinning Tops (add $145; limit 10; 3:30pm-4:30pm):Using LEGO® WeDo kits, you’ll learn the basics of robotics & computational thinking. Build a dancing bird & drumming monkey to learn how motors, sensors, & programming apply to the robotic concept of movement. The class will finish w/ the building of a top for the Battle of Spinning Tops! Intermediate Level: If you’ve already participated in an earlier Jr. Robotics session, you’ll build a rescue helicopter, earthquake machine & a Mars rover. This group will use LEGO® WeDo 2.0 kits which can be disconnected from the computer for testing the programs.

Sibling Discount Part-time participants are granted a 10% sibling discount for the

2nd & each successive sibling registered for equal or lesser value.

*Discount does not apply to full-time participants,

additional blocks, or activity fees.

How To Register Fax: Those who have a WPC Charge Card Authorization Form on file may fax completed registration forms to 978-392-4471.

Mail: Complete form, include check and/or WPC Charge Card Authorization Form & mail to: PO Box 2444, Westford, MA 01886 Walk-In: Registrations & payment accepted Mon-Fri, 8am-4pm. After hours: use mail slot in front door.

No forms will be accepted by sites/staff. No emailed registration forms will be accepted.

Registration forms & payment must be received by noon, one week prior to start date. Late forms incur a $25 late fee. NO EXCEPTIONS. Payment MUST include late fee/no registration fee(s) if applicable.

WPC POLICIES AT A GLANCE •You must register for at least 1 block, 1 day a week for the entire session. We do not allow any withdrawal/switching of days. •No credits/refunds will be given for inclement weather, illness, absences or other conditions beyond the control of the Rec. Dept. •Forms must be submitted by noon, 1 week prior to start date. Late forms incur a $25 late fee. NO EXCEPTIONS. Children who attend program w/out being registered for that session will pay $15/day in addition to the late fee, as well as daily block fee(s). A child is registered only after form & payment have been received & processed by the Rec. Dept. •Each child must have a Child Info Form filled out by a parent/guardian & submitted to Rec. Dept. prior to start date. •Absences must be reported to the Rec. Dept. by noon that day, or you will incur a $10 finder’s fee. After three occurrences, the fee will increase to $15. Absentee lists are not relayed to us. •If someone other than those listed as authorized to pick up your child will be picking them up, we must be notified in writing. •You are expected to pick up your child(ren) promptly after their scheduled block ends or they will be placed in the next block & you will incur the full block fee of $11. You will be charged $1/minute after 6 p.m. After three occurrences, the fee will increase to $2/minute & you will be asked to schedule a meeting w/ the WPC Director. •Charge card payments can only be made by submitting a WPC Charge Card Authorization Form. Any additional blocks/days you would like to add to your child(ren)’s schedule must be paid via credit/debit card. For a full list of our policies and procedures, please refer to the

WPC Parent Handbook which can be found at www.westfordrec.com

SESSION 4 SCHEDULE

NO WPC *March 25: Good Friday

NO SCHOOL/SPECIAL PROGRAMS *March 10: K-5 Conferences *April 18-22: Spring Break Full-day programs offered

EARLY RELEASE *March 17: Prof. Dev. *April 13: Prof. Dev.

Early release days are included as a regular registration day.