PERIOD ZERO REGISTRATION Session 1 (Sept 7-Oct 26)
Period Zero is a combination of free programming and fee-based enrichment classes offered by the YMCA of Boulder
Valley at Louisville and Centennial Middle Schools during Wednesday morning late start days from 7:30-9:25am that
provides activities and clubs for students in an exciting and safe environment. Period Zero runs every Wednesday all
school year. This form is due by Sept 2. Submit to your school office or email to [email protected].
Child’s Name____________________________________________________________________________________________ Age________________________________ Gender M
Louisville
/ Centennial
Grade: 6th
/ 7th
/F
DOB_______________________________
/ 8th
Parent Name________________________________________________________________ Phone________________________________________________ Email�����������������������������������������������������������������
Parent Name________________________________________________________________ Phone________________________________________________ Email�����������������������������������������������������������������
Emergency Contact________________________________________________________ Phone________________________________________________ Email�����������������������������������������������������������������
Medical conditions or allergies_________________________________________________________________________________________________________________________________________________________________________
Reaction______________________________________________________________________________________________________________________________________________________________________________________________________
Waiver: My child is in good health and is capable of participating in YMCA activities. 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. Photos and/or videos of my child in YMCA
activities may be used as promotion or for educational/training purposes for the YMCA unless otherwise requested in writing on the child’s emergency form.
The YMCA may end my families’ participation in YMCA programs for any of the following reasons: Behavior by my child that poses a threat to the
safety of him/herself or others or is in violation YMCA of BVSD policies. Leaving the direct supervision of a staff person without permission.
Participation Contract: 1) My child (student) must sign in each morning when arriving at Period Zero. 2) My child (student) must remain in the Period Zero
program until dismissed by YMCA staff. 3) My child (student) must uphold the YMCA core values of Caring, Honesty, Respect and Responsibility.
4) My child (student) will follow all school rules and policies while participating in Period Zero activities.
Parent/Guardian Signature_________________________________________________________________________________________________________________________Date_______________________________________________
Student Signature_____________________________________________________________________________________________________________________________________Date_______________________________________________
ENRICHMENT CLASSES (please select only one as the classes all run at the same time)
Free Enrichment Class: Classes run from 7:30-9:25am every Wednesday. Only one registration form required per school year for this class.
Open Gym, Games, Homework Room
Fee-based Enrichment Classes: Eight week sessions are $80 and run from 8:25-9:25am every Wednesday. No credits or refunds offered after registration
has been handed in. Financial assistance available to those who qualify.
Session 1: Sept-7-Oct 26 (registration due by Sept 2).
Painting and Drawing: Self-expression and exploration of different art techniques in a fun, welcoming, safe environment, providing students an
opportunity to dive deeper into their artistry, or discover it for the first time.
Theatre and Improv: Newbies and veterans alike will have fun playing theatre games, creating wacky characters and learning the basics of improv.
Hip Hop Dance: This introductory class covers basic movements across different “street dance” styles including breaking, popping, house and locking. The
class will teach foundation for each style as well as introductory hip hop choreography combining movements from different genres of dance.
Yoga / Mindfulness: This class is specifically designed for middle school students. Help start your day with exercises that help energize your body and help
you get through a hard day at school. Students will learn to focus on breathing, flexibility, balance and coordination as they strengthen and build themselves.
Payment Info:
Cash
Check #_____________________________________ (payable to YMCA of Boulder Valley)
Visa/MC/Amex/Disc Card #__________________________________________________________________________________________________VIN Code____________________ Exp. Date____________________________
Responsible Party Name (print)_______________________________________________________ Signature___________________________________________________________________Date____________________________
Additional enrichment classes will be available throughout the year. Session 2: Nov 2-Jan 11, Session 3: Jan 18-March 8, Session 4: March 15-May 10
For more information contact the Teen Department at 303-443-4474 x4651 or at [email protected].
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