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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.