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YMCA OF GREATER SEATTLE Kids University Registration Form -
Timber Ridge Elementary
CHILD’S INFORMATION
Legal First Name
MI Legal Last Name
School Attending Birthdate Grade Gender
Address City Zip Code
MONTHLY CARE OPTIONS COMMUNITY MEMBER RATE FACILITY 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 registration 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 & POLOCIES
Classes take place at Snoqualmie YMCA and Timber Ridge
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. 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
Email
Phone Number
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
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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: ________________________________
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TIMBER RIDGE KIDS UNIVERSITY REGISTRATION FORM Session 4:
February 26 - April 27, 2018
E
SNOQUALMIE YMCA
35018 SE Ridge St, Snoqualmie, WA 98065
P 425 746 9900 F 425 746 6265 seattleymca.org
Child Name Grade Birthdate Gender
Monday Tuesday Wednesday Thursday Friday
Early Release 1 1:30pm-2:30pm
Bollywood/Bhangra $170.00
or Art Expression By Branch Out
$240.00
or
Cardio Blast
or
Dr. Seuss K - 2nd Grade
or
Outdoor Games
Early Release 2 2:30pm-3:30pm
Cartoon College 2
Or
Basketball 101 2nd - 5th Grade
Or
Lego Time
Class 1 3:30pm-4:30pm
Gymnastics $165.00
Dreamwork, Teamwork
Guitar With Bill $196.00
Field Fun Creation Station or or
Beady Buddies Creating Critters
Or Or Or or or
Gym Games Sports of All Sorts Sportsmanship Revamp
2nd - 5th Grade Sports of All Sorts
Dodgeball Or Or Or Or
Drama: One Act Plat 2nd - 5th Grade
Think Tank Parachute Games
K - 1st Grade Think Tank
Class 2 4:30pm-5:30pm
STEM Crafty Creations Builders Workshop Fantastic Fiction 2nd -
5th Grade
Waffles of the World
Or Or Or Or Or
Ballerific Dodgeball Gym Time 2 Tag It, Run It Minute to Win
It
Class 3 5:30pm-6:00pm
Read to me K - 2nd Grade
Board Games Lego Time Cool Coloring Hit the Deck or
Write On 2nd - 5th Grade
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
Partic-ipants, 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
Email to: [email protected]
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VENDOR CLASSES
YMCA LED CLASSES
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. We
love repeat students! New projects are introduced from session to
session. Grades K-5
Bollywood/Bhangra Are you ready to dance? My Dance World Academy
is excited to start offering dance classes for boys and girls.
Bollywood and
Guitar with Bill Students will have fun learning the guitar.
Guitar skills including chords, notes, and how to read guitar
tablature will be prac-
Gymnastics This is a class for beginning to intermediate girls
and boys. We will teach skills on bars, beam, vaulting and in
tumbling. Grades
Ballerific How many different games can we play with a ball?
Find out in Ballerific!
Basketball 101 (2-5) Enjoy a classic winter sport with your
2nd-5th grade friends and Y staff!
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.
Builders Workshop Join a YMCA instructor as you learn the basics
of building. You will use a variety of mediums including;
marshmallows, tooth-picks, playing cards, and many more fun unique
building materials.
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 2 Ever wonder where cartoonists learned to draw?
Well, in Cartoon College we will learn some of the basics of this
hilarious art form.
Cool Coloring Relax while listening to a variety of stories!
Crafty Creations Kids will learn to create fun & unique
projects including: slime, kinetic sand, puppets & much
more!
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.
Creation Station Use your imagination as you create your own art
each week using a variety of mediums including paint, clay, oil
pastels, chalk and paper. We will focus on a different medium each
week. Choose what you want to make each class.
Dodgeball Enjoy a classic elementary school game while learning
new variations to play with ends!
Dr. Seuss K - 2nd Grade
Listen to and experience classic Dr. Seuss stories through a
variety of art activities and games with other Kindergarten-2nd
grad-ers.
Drama: One Act Play 2nd -5th Grade
Work together with a group of other 2nd-5th grade students to
put on a mini-play. There will be a role for everyone! Learn to
project your voice, open up to the audience and have a stage
presence. We will also learn about blocking.
Dreamwork, Teamwork Students will learn the value of teamwork by
playing a completing a variety of games and activities.
Fantastic Fiction 2nd - 5th Grade
Students will develop their inner story teller through group
games, imaginative thinking, reading, storytelling, and creative
writing.
Field Fun Get outside and on the field to play fun games
including kickball, world cup and more.
Gym Games Learn a variety of new games from board games to
puzzles to group games, anything you can think of.
Gym Time 2 Spend time in the gym learning new games and playing
some great classics with a twist!
Hit the Deck Gather around and learn different card games!
Compete and learn strategies to get ahead!
Lego Time With Legos, the only limit is your imagination.
Challenge yourself to build new creations each week!
Minute to Win It Can you win in a minute? Compete in cool
challenges to become the Minute Champion!
Outdoor Games Get outside and play! Learn new outdoor games to
play with ends or in school!
Parachute Games k - 1st Grade
Learn some cool new games to play with a PE favorite, a giant
parachute. Play with other Kindergarten-1st graders in this great
class.
Read to Me K - 2nd Grade
Relax while listening to a variety of stories!
Sports of All Sorts Learn some of the most popular sports each
week while talking about teamwork and sportsmanship.
Sportsmanship Revamp 2nd - 5th Grade
Discover the importance of sportsmanship through interactive
games and activities while working with other 2nd-5th graders.
STEM Challenge yourself while conducting experiments and
creating crafts involving science, engineering, and fun!
Tag it, Rut it Get active with some fun new tag games!
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.
Waffles of the World Waffles are a fun breakfast food but not
every waffle has to be for breakfast! We’ll be learning about other
countries food and convert that into a waffle!
Write On 2nd - 5th Grade
Challenge yourself while conducting experiments and creating
crafts involving science, engineering, and fun!
Legal First Name: MI: Legal Last Name: School Attending:
Birthdate: Grade: Gender: Address: City: Zip Code: By Class:
OffAfter School Enrichment Pass: OffBefore School Fun and Fit Pass:
OffNo School Days: OffLegal First Name_2: Legal Last Name_2:
Birthdate_2: Gender_2: Email: Phone Number: Please indicate any
health concerns or allergies that we need to be aware of List NONE
if not applicable to your child: Lists any behavioral needs or
concerns we should be aware of: List any medications that need to
be administered during program hours: Please provide an emergency
contact number other than the number provided above: undefined:
egal First Name: MI_2: Address_2: Phone Number_2: undefined_2:
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initial_4: initial_5: Child Name: Grade_2: Birthdate_3: Gender_3:
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