YMCA OF GREATER SEATTLE

Kids University Registration Form—Margaret Mead 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 avail-

able 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 Margaret Mead 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 YMCA

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: ________________________________

MARGARET MEAD 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

Outdoor Games

or

Creating Critters

Class 1 3:00pm-4:00pm

Dodgeball

Mad Science Crazy Chemworks 1st - 5th Grade

$193.00

Holidays Around The World

KIDSTAGE Acting K - 2nd grade

$159.00

Bollywood/Bhangra $152.00

or

Scratch Coding 2nd - 5th Grade

$205.00

or or

Beady Buddies

Off to the Races

or or or or

Think Tank

Art of Throwing

Soccer Skills Felt At or or

Washington Wildlife Got Hops?

Class 2 4:00pm-5:00pm

Disney Mania Draw With Me Fuse / Loom Hoop It Up Gym Time

or or or or or

Brainy Builders All Sorts of Sports Tag it, Run it Smart Art Nature Crafts

Class 3 5:00pm-6:00pm

Reading Corner Lego Time Cool Coloring Board Games Crazy Cards

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 Participants, please add $15.00 additional per class.

Monday Tuesday Wednesday Thursday Friday

Early Release $169

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

Class 2 $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 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

YMCA LED CLASSES

Bollywood/Bhangra Are you ready to dance? My Dance World Academy is excited to start offering dance classes for boys and girls. Bollywood and Bhangra dance is high energy and fun for all ages. Grades K-5th

KIDSTAGE Acting Bring colorful characters to life through creative stories, games, and teamwork. Put it all together on stage for friends and family. Exploratory acting classes provide literature-based drama activities that promote literacy comprehension, confidence, collabora-tion, and creativity. Grades K-2nd

Mad Science: Crazy Chemworks

The wonders of chemistry are revealed as our junior chemists create surprising concoctions, break molecules with ease and shake up a flask full of fun. Kids will use the tools, safety procedures and laboratory techniques of real chemists as they investi-gate solids, liquids and gases at the atomic level. They’ll craft chemical combinations to create super-sticky-stuff, analyze the properties of light and ooze into the world of polymers. Exploring the elements has never been so much fun! Grades 1st-5th

Scratch Coding

Students will develop coding skills in Scratch, an open source MIT application, and will explore basic programming concepts. When kids learn to code in Scratch, they learn important strategies and logics for solving problems, designing projects, and com-municating ideas. Students will do many hands-on exercises to learn the concepts. Finally, they will get engaged in creating their own video games and animated stories by themselves or in a team. Pre-requisites (Coding 101, or prior knowledge of scratch). Grades 2nd-5th.

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.

Art of Throwing In this class, kids will learn various ways to throw different sport-related projectiles properly, and practice for more accuracy.

Beady Buddies Use beads to create fun creatures each week!

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

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

Cool Coloring Relax and unwind in this coloring class.

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

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.

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!

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

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

Fuse/Loom Enjoy this art form each week by fusing a variety of projects.

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

Gym Time Spend time in the gym learning new games and play some great classics!

Holidays Around the World Learn about holidays from different countries through arts and crafts!

Hoop It Up Work on dribbling, passing and shooting to develop basketball skills.

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.

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

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

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

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

Soccer Skills The most popular sport in the world get broken down to basics so those that know and teach and those that don't can learn.

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

Think Tank Take time to work on any school projects, homework, or free choice learning.

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 Washing-ton wildlife activities and crafts.

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