YMCA OF GREATER SEATTLE

Kids University Registration Form—Snoqualmie Valley YMCA Cascade View Elementary and Snoqualmie 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)

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

hours and days in the week Does not include cost of Non-Student Days & Breaks

$470/month +

$50 registration fee

$525/month +

$50 registration fee

□ Before School Fun and Fit Pass Monthly Fee includes the choice of your class for each of

hours and days in the week Does not include cost of Non-Student Days & Breaks

$310/month ($105/month with registra-

tion of Enrichment Pass) +

$50 registration fee

$360/month ($125/month with registration of

Enrichment Pass) +

$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 Snoqualmie YMCA between the hours of 7:00am until school begins and 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. Payment 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 Snoqualmie School 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 through the Y and 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): ______________________________________________________________________

https://apm.activecommunities.com/seattleymca/Activity_Search?txtActivitySearch=52890%20|%2052883%20|%2052886%20|%2052884%20|%2052885https://apm.activecommunities.com/seattleymca/Activity_Search?txtActivitySearch=52808https://apm.activecommunities.com/seattleymca/Activity_Search?txtActivitySearch=52812http://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: ________________________________

SNOQUALMIE YMCA KIDS UNIVERSITY REGISTRATION FORM Cascade View and Snoqualmie Elementary

Session 4: February 26 - April 27, 2018 Child Name Grade Birthdate Gender

Monday Tuesday Wednesday Thursday Friday

Early Release 1 1:30pm-2:30pm

Duct Tape Art

or

Fantastic Fitness

or

Just Dance

Early Release 2 2:30pm-3:30pm

All Sorts of Sports

or

Krafty Kids

or

Jewelry Making

Class 1 3:30pm-4:30pm

Pacific Northwest Painters

Art Expression By Branch Out

$240.00

Color Me Mine Art Club $152.00

Guitar with Bill $196.00

Group Games or or or

Build It Artists Showcase Creating Critters

or or or or or

You’re It K - 2nd Grade

Create A Sport Off to the Races Activities For A Rainy Day

Fuse Beads or or or or

Outdoor Games 2nd - 5th Grade

Think Tank Think Tank Basketball Basics 2nd - 5th Grade

Class 2 4:30pm-5:30pm

Cartoon College Bead Creations Gym Games

Introduction to Marital Arts K - 2nd Grade

$129.00 Master of Mazes

or

3D Art

or or or or or

Fantastic Fitness Ballerific Winter Wonderland Diamond Dazzlers

(Baseball) You’re It

Class 3 5:30pm-6:00pm

Draw With Me Read to Me All Sorts of Sports

Introduction to Martial Arts 2nd - 5th

5:30 - 6:30PM $129.00

Parachute Games or

Crafty Creation

or or or or

Frisbee Golfs Cardio Blast Brain Games Frisbee Golfs

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 Par-ticipants, please add $15.00 additional per class.

Monday Tuesday Wednesday Thursday Friday

Early Release 1 $100

Early Release 2 $100

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

Class2 $100 $100 $100 $100 $100

Class 3 $50 $50 $50 $50 $50

SNOQUALMIE YMCA

35018 SE Ridge St, Snoqualmie, WA 98065

P 425 746 9900 F 425 746 6265 seattleymca.org

E

Email to: eastsidechildcare@seattleymca.org

VENDOR CLASSES

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

Activities for a Rainy Day Playing, creating games and exciting crafts1 Each week will be a new activity to enjoy indoors when the weather is grey.

All Sorts of Sports Sports, sports, and more sports! Play traditional sports such as; basketball, soccer, football. Or get wild and wacky with basket-ball, bump, and capture the flag.

Artist Showcase Come learn about the different styles of art from the perspective of many famous artists throughout our history. We will show different styles and techniques that will broaden everyone’s artistic views.

Ballerific How many different games can we play with a ball? Find out in Ballerific!

Basketball Basic (2nd-5th) The YMCA created sport that is now know around the world. Let's bring it back to basics so we learn how to dribble and move before we play some games.

Bead Creations Learn to make cool creations from awesome necklaces to beady buddies.

Brain Games Challenge your brain with a variety of brain teasers and challenges.

Build It Express your inner engineer while designing these builds just the way you want to.

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

Cartoon College Do you like to draw? This is your chance to learn the basics about drawing cartoons. We will create everything from animals to characters in your quest to master the art of cartooning.

Crafty Creations Kids will learn to create fun & unique projects including: slime, kinetic sand, puppets & much more!

Create a Sport Use everyday household items to get creative and come up with a new game each week as a group.

Creating Critters Students will be given the chance to be creative and explore working with different materials to create a small animal to take home each class.

Diamond Dazzlers( Baseball)

The course will be teaching the basics of baseball, from running to throwing to sliding and more.

Draw with Me Enjoy the relaxed of Different types of drawing, with the instructors.

Duct Tape Art Duct tape can create some of the coolest art pieces and functional art. Bring your creativity and tape ripping skills to this fun and inventive class.

Fantastic Fitness Challenge yourself to get healthier and get moving. Can you improve your physical fitness by the end of the session? Track your progress as you go each week!

Frisbee Golfs By the end of the quarter, each student will have learned and improved on their Frisbee throwing skills and target practice, while obtaining a basic understanding for the game of Frisbee golf.

Fuse Beads Kids are given the chance to be creative and create an awesome bead design that they can iron and take home!

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 Games Learn a variety of new games from board games to puzzles to group games, anything you can think of.

Jewelry Making Create fantastic pieces from bracelets, rings, necklaces, and more. Use mediums that include beads, wire, paper, and clay. Eve-ryday participants will take home a priceless treasure.

Just Dance Bust a move with your ends and Y staff as we dance you through a variety of music styles.

Krafty Kids Kids will learn how to make fun and easy crafts and take them home.

Master of Mazes Learn all about solving mazes and even make your own maze for your friends to solve!

Off to the Races Get ready to run, hurdle, and scoot your way to the finish line in this active class!

Outdoor Games (Grade 2-5)

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

Art Expression: By Branch Out

Art Expression is an 8 week program designed to encourage and further develop imagination, creativity and self-discovery. Children expand their creative interests and expression through the exploration of various art mediums, which may include painting, sculpting, pottery, collage, mosaic, clay, drawing and more. Grades K-5th

Color Me Mine Art Club

Students will create exciting art projects & learn new techniques each week. Both ceramic and canvas painting demonstrated! Grades K-5th

Guitar with Bill Students will have fun learning the guitar. Guitar skills including chords, notes, and how to read guitar tablature will be practiced. All playing levels are welcome. Guitars will be provided during class for students without a guitar. Grades K-5th

Intro to Martial Arts Introduction to basic Tae Kwon Do. This class will meet at the Snoqualmie Valley YMCA, and a instructor will walk them to the DMW Martial Arts Studio for class. Pick up will be 5:10pm at the Studio after class. There is a $49 uniform charge to be made at the DMW Studio before the first day of class. Grades K-2nd

Intro to Martial Arts Introduction to basic Tae Kwon Do. This class will meet at the Snoqualmie Valley YMCA, and a instructor will walk them to the DMW Martial Arts Studio for class. Pick up will be at the Studio after class. There is a $49 uniform charge to be made at the DMW Studio before the first day of class. Grades 2nd-5th

YMCA LED CLASSES

Pacific Northwest Painter During the course students will learn about and paint Pacific Northwest landscapes.

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

Read to Me Come relax and read while building reading skills and vocabulary.

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.

Winter Wonderland Design different arts and crafts that capture the beauty of winter!

You're It Run, Run, Run as you learn new tag games in this fun and heart pounding class.

You're it (Grade K-2) Learn new variations to the classic recess game of tag, from Dab tag to Zone tag and more.

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