1. No category

Contact your school’s site director for more info.
THEME: WINTER WONDERLAND
KIDS NIGHT IN
FRIDAY, JAN 27, 2017 • 6:00-9:30PM
Bring your K-5th graders for a fun night in while you have a
relaxing night out. Go out for a relaxing dinner, see a movie
with friends or just get the shopping done in peace. We
have fun winter-themed activities planned including making
watercolor snowflakes and cross country skiing. We’ll have a
nutritous dinner and snowman cookies for dessert.
BCSIS & High Peaks
Blaire Laurie, 720-394-7804
[email protected]
Flatirons & Whittier
Scott VandeNoord, 720-412-6544
[email protected]
Bear Creek & Mesa
Trevor Wood, 720-269-9377
[email protected]
Longmont Y
Jenna Capnerhurst, 970-281-9997
[email protected]
Creekside & Eisenhower
Myriah Hunsley, 720-292-7223
[email protected]
Louisville
Jake McClory, 303-709-2477
[email protected]
Columbine & Foothill
Vic Cordts, 720-394-7936
[email protected]
Superior
Kelsey MacIlvaine, 720-771-0674
[email protected]
Crest View
Santina Bleil, 720-544-3422
[email protected]
Uni-Hill
Jon Hamre, 720-394-8807
[email protected]
Registration is due to your site director no later than Tuesday, January 24.
Kids Night In is held at the following schools. Please check the school your child will attend for Kids Night In.
BCSIS/High Peaks
Foothill
Bear Creek
Longmont Y
Creekside
Louisville
Mesa
Crest View
Superior
Eisenhower
Uni Hill
Flatirons
Whittier
Child’s Name__________________________________________________________________________________________________________________ Age_______________ DOB__________________________________ Gender
M
F
Address____________________________________________________________________________________________________ City________________________________________________________________ Zip_______________________________
School_________________________________________________________________________________________________________________________________________________________________________ Grade_____________________________
Parent/Guardian______________________________________________________________________________________________________________________________________________________________ DOB_____________________________
Home #_________________________________________________________ Cell #_____________________________________________________________ Email________________________________________________________________________
Parent/Guardian______________________________________________________________________________________________________________________________________________________________ DOB_____________________________
Home #_________________________________________________________ Cell #_____________________________________________________________ Email________________________________________________________________________
Emergency Contact Name______________________________________________________________________________________ Relationship to Your Child_____________________________________________________________
Home Phone_______________________________________________________________________________ Cell Phone_________________________________________________________________________________________________________
Address____________________________________________________________________________________________________ City________________________________________________________________ Zip_______________________________
Medical Conditions/Allergies_________________________________________________________________________________________________________________________________________________________________________________
Reaction___________________________________________________________________________________________________________________________________________________________________________________________________________
Special Needs/Concerns_______________________________________________________________________________________________________________________________________________________________________________________
How did you hear about this program? ___________________________________________________________________________________________________________________________________________________________________
Waiver: My child is in good health and is capable of participating in Kids Night In. I understand the potential risks of participation and hold harmless the YMCA, staff, directors and
volunteers from accidents resulting from participation. I authorize, in a medical emergency, after reasonable effort has been made to notify parents, that a YMCA representative may
seek emergency assistance at the parent/guardian’s expense.
Parent/Guardian Signature__________________________________________________________________________________________________________________________Date___________________________________________________
Y Member $20 (Family Membership
Year-Round or School Year Plan
)
Non-member $30 (Drop-in
)
Financial Assistance
CCAP $7 per child
$5 sibling discount available. Financial assistance is available to those who qualify. Contact your school's site director for details.
Payment: Cash
Check #________________________ Visa/MC/Amex/Disc #______________________________________________________________________________________________ Exp Date___________________
Cardholder Name__________________________________________________________________________ Signature___________________________________________________________________________Date________________________
Internal Use Only: Intake Name_____________________________________________________________________________________________________________________________________________Date________________________
YMCA OF BOULDER VALLEY
ymcabv.org
Serving Boulder, Broomfield & Weld Counties
Arapahoe Center 2800 Dagny Way • Lafayette, CO 80026 • 303-664-5455
Ed & Ruth Lehman Center 950 Lashley Street • Longmont, CO 80504 • 303-776-0370
Mapleton Center 2850 Mapleton Avenue • Boulder, CO 80301 • 303-442-2778
Contact your school’s site director for more info.
TEMA: MARAVILLOSO INVIERNO
NOCHE PARA NIÑOS
VIERNES 27 DE ENERO, 2017 • 6:00-9:30PM
Traiga a sus niños de K-5to grado a una noche divertida mientras que
usted tiene una noche para relajarse y salir. Vaya a cenar, a ver una
película con sus amigos o tal vez solamente a hacer las compras en
paz. Tenemos planeadas divertidas actividades con el tema de invierno,
incluyendo hacer copos de nieve con acuarela y esquí a campo traviesa.
Tendremos también una nutritiva cena y galletitas de muñecos de nieve
de postre.
BCSIS & High Peaks
Blaire Laurie, 720-394-7804
[email protected]
Flatirons & Whittier
Scott VandeNoord, 720-412-6544
[email protected]
Bear Creek & Mesa
Trevor Wood, 720-269-9377
[email protected]
Longmont Y
Jenna Capnerhurst, 970-281-9997
[email protected]
Creekside & Eisenhower
Myriah Hunsley, 720-292-7223
[email protected]
Louisville
Jake McClory, 303-709-2477
[email protected]
Columbine & Foothill
Vic Cordts, 720-394-7936
[email protected]
Superior
Kelsey MacIlvaine, 720-771-0674
[email protected]
Crest View
Santina Bleil, 720-544-3422
[email protected]
Uni-Hill
Jon Hamre, 720-394-8807
[email protected]
Debe entregar la inscripción al director del sitio antes del 24 de enero.
La Noche de niños se llevará a cabo en las siguientes escuelas. Por favor marque a la que su hijo asistirá a este evento.
BCSIS/High Peaks
Foothill
Bear Creek
Longmont Y
Creekside
Louisville
Mesa
Crest View
Superior
Eisenhower
Uni Hill
Flatirons
Whittier
Nombre del niño__________________________________________________________________________________________________ Edad_____________Fecha de Nac_____________________________________ Sexo
M
F
Dirección_______________________________________________________________________________________________Ciudad__________________________________________________ Código postal_______________________________
Escuela________________________________________________________________________________________________________________________________________________________________________ Grado_____________________________
Padre/Guardián____________________________________________________________________________________________________________________________________________________Fecha de Nac_____________________________
Tel Hogar_______________________________________________________ Cel #_____________________________________________________________ Email________________________________________________________________________
Padre/Guardián____________________________________________________________________________________________________________________________________________________Fecha de Nac_____________________________
Tel Hogar_______________________________________________________ Cel #_____________________________________________________________ Email________________________________________________________________________
Contacto de emergencia________________________________________________________________________________________________ Relación con su hijo_____________________________________________________________
Home Phone_______________________________________________________________________________ Cell Phone_________________________________________________________________________________________________________
Dirección_______________________________________________________________________________________________Ciudad__________________________________________________ Código postal_______________________________
Condiciones médicas/Alergias ______________________________________________________________________________________________________________________________________________________________________________
Reacción___________________________________________________________________________________________________________________________________________________________________________________________________________
Necesidades especiales/Preocupaciones_________________________________________________________________________________________________________________________________________________________________
¿Cómo escuchó de este programa?_________________________________________________________________________________________________________________________________________________________________________
Derogatoria: Mi hijo está en buena salud y es capaz de participar en la Noche para niños. Entiendo los riesgos potenciales de la participación y mantengo al YMCA, al personal,
directores y voluntarios sin daño por accidentes que resulten de esta participación. Yo autorizo, en una emergencia médica, después de esfuerzo razonable para notificar a los padres,
que un representante del YMCA busque ayuda de emergencia a costo del padre o guardián.
Firma del padre/Guardián _________________________________________________________________________________________________________________________ Fecha___________________________________________________
Miembro $20 (Membrecía/Familia
Anual o Plan de año escolar
)
Sin membrecía $30 (Drop-in
)
Ayuda financiera
CCAP $7 por niño
Descuento de $5 por hermanos disponible. Ayuda financiera para los que califiquen. Contacte al director de su sitio para mas detalles.
Pago: Efectivo
Cheque #______________________ Visa/MC/Amex/Disc #_____________________________________________________________________________________________ Fecha Exp___________________
Nombre en la tarjeta___________________________________________________________________________Firma_________________________________________________________________________ Fecha________________________
Internal Use Only: Intake Name_____________________________________________________________________________________________________________________________________________Date________________________
YMCA OF BOULDER VALLEY
ymcabv.org
Serving Boulder, Broomfield & Weld Counties
Arapahoe Center & Corporate Office 2800 Dagny Way • Lafayette, CO 80026 • 303-664-5455
Ed & Ruth Lehman Center 950 Lashley Street • Longmont, CO 80504 • 303-776-0370
Mapleton Center 2850 Mapleton Avenue • Boulder, CO 80301 • 303-442-2778