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YMCA OF GREATER SEATTLE Kids University Registration Form -
Timber Ridge Elementary
CHILDS 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 months 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 YMCAs 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 5: April
30 - June 12, 2018
ESNOQUALMIE 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
Art Expression By Branch Out
$185.00
or
Fun Bunch K - 2nd Grade
or
Outdoor Games
or
Playground Fames
Early Release 2 2:30pm-3:30pm
STEM Challenges 2 - 5th Grade
Or
Youre It
Or
Art 101
Class 1 3:30pm-4:30pm
Gymnastics $110.00
Gym Time 2
Guitar With Bill $152.00
Mad Science Special Agent Lab
1 - 5th $136.00
Challenge Accepted or or or
Holy Hoops Wednesday Walkers Field Fun
Or Or Or or or
Washington Wildlife Recycle Music Sewing
2 - 5th Grade A Blast to The Past
2 - 5th grade
Wonders of The World Or Or Or Or
Think Tank Cooking Skills 2 - 5th Grade
Think Tank Holidays Around The
world
Class 2 4:30pm-5:30pm
The Art of Throwing Gaelic Football Gaga Ball Dodgeball III
Slime Time
Or Or Or Or Or
Felt Art Kool KNex Movin Move Mania Animal Adventures
Ballerific
Class 3 5:30pm-6:00pm
Beady Buddies Card Games String It Up Dice Games Origami
Masters
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 $63
Early Release 2 $63
Class 1 $75 $88 $75 $75 $63
Class2 $75 $88 $75 $75 $63
Class 3 $38 $44 $38 $38 $31
Email to: [email protected]
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VENDOR CLASSES
YMCA LED CLASSES
A Blast to the Past! (2-5) Who ever said history is boring? They
were wrong! In this class, kids will learn about a few of the
important events that shaped our country. Students will then create
awesome crafts and STEM activities to go along with the lesson.
Animal Adventures Learn cool and interesting facts about animals
while making new art projects!
Art 101 Calling all artists! This course will explore different
drawing techniques and tools/materials used for art.
Ballerific How many different games can we play with a ball?
Lets find out in Ballerific!
Beady Buddies Learn to make different bead creatures each week
following unique patterns!
Card Games Enjoy new and classic card games during this
class.
Challenge Accepted Work independently and in groups to solve and
create challenges fun for everyone.
Cooking Skills (2-5) Come learn some basic cooking skills, and
plan a meal!
Dice Games Learn new games to play with a basic set of dice.
Dodgeball III Enjoy a classic elementary school game while
learning new variations to play with friends!
Felt Art Learn how to use felt for a variety of projects
including lollipops, pillows, and more!
Field Fun Get outside and on the field to play fun games
including kickball, world cup and more.
Fun Bunch (K-2) Introduce younger kids to fun art and crafts,
educational games and more!
Gaga Ball Join Y staff as you learn and play the fun game of
GAGA.
Gym Time 2 Spend time in the gym learning new games and playing
some great classics with a twist!
Holidays around the World Learn about holidays from different
countries through arts and crafts!
Holy Hoops Learn the basics of basketball by learning a variety
of techniques and rules to play the game.
Kids U Gaelic Football Students will learn an exciting new game
from Ireland which involves speed, skill and will improve teamwork
and coordination.
Kool K'nex Improve your fine motor skills as you create
different projects with these fun building blocks!
Movin' Movie Mania Course Description: Each week, kids will be
completing art projects and/or games related to some of the most
popular movies
Origami Masters Its all about Paper folding. From balloons to
boxes, cranes to frogs, well do it all! Create some fantastic
pieces to take home each day.
Outdoor Games Get outside and play! Learn new outdoor games to
play with ends or in school!
Playground Games Playing outdoors is great especially different
playground games! This course will explore different games that can
be played on the playground.
Recycle Music Take everyday objects and turn them into musical
creations!
Sewing (2-5) Students will different terms relating to sewing
and the skills for basic projects.
Slime Time Explore the different states of matter as you create
messy projects!
STEM Challenges (2-5) Like to build and create things? Each week
you will work in a team to build and construct different challenges
and solve problems to complete tasks.
String it up We use string in so many different craft, so now
well do some craft that the main material will be the string,
whether its for friendship bracelets or a new toy
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
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
Gymnastics This is a class for beginning to intermediate girls
and boys. We will teach skills on bars, beam, vaulting and in
tumbling. Grades K-5
Mad Science: Special Agent Lab
Explore how STEM is used to solve crimes and reveal the secrets
of spies with our Special Agent Lab. Inspect crime scenes through
the eyes of a detective, analyze evidence with forensic science,
sharpen your skills of observation and test your powers of
deduction. Your agent-in-training will build security systems to
keep secrets safe, use cyphers to send secret messages and learn
how technology works in the top-secret world of espionage. Uncover
the science of sleuthing with our Special Agent Lab! Grades 1st
-5th
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YMCA LED CLASSES The Art of Throwing In this class, kids will
learn various ways to throw different sport-related projectiles
properly, and practice for more accuracy.
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.
Washington Wildlife Want to learn more about the wildlife that
lives in our own state? This course will help you explore
Washingtons wilderness by learning about the animals and plants
that live right outside our homes.
Wednesday Walkers Have you ever wondered how far you have walked
during the course of a day? Participants will be learning about the
benefits of walking and how to track just how far they go.
Wonders of the World A class for all young adventurers! Learn
about the classic wonders of the world as you create mini replicas
of each design.
Your'e it Learn new variations to the classic recess game of
tag, from Dab tag to Zone tag and more.
Timber Ridge Session 5YGS Payment Authorization Form
YEP.Fall.20161
Legal First Name: MI: Legal Last Name: School Attending:
Birthdate: Grade: Gender: City: Zip Code: By Class: After School
Enrichment Pass: Before School Fun and Fit Pass: No School Days:
Legal First Name_2: Legal Last Name_2: Birthdate_2: Gender_2:
Email: 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: Child Name: Grade_2: Birthdate_3:
Gender_3: Check Box1: Check Box2: Check Box3: Check Box4: Check
Box5: Check Box6: Check Box7: Check Box8: Check Box9: Check Box10:
Check Box11: Check Box12: Check Box13: Check Box14: Check Box15:
Check Box16: Check Box17: Check Box18: Check Box19: Check Box20:
Check Box21: Check Box22: Check Box23: Check Box24: Check Box25:
Check Box26: Check Box27: Check Box28: Check Box29: Check Box30:
Check Box31: Check Box32: Check Box33: Check Box34: Check Box35:
Check Box36: Check Box37: Check Box38: Check Box39: M: Address:
Phone Number: undefined_2: undefined_3: undefined_4: undefined_5:
understand I will not be fully registered until this is provided:
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