Name: 44 CAMP HOTLINE 522-SUMM or

Transcription

1 CAMP HOTLINE 522-SUMM or

2 2018 Swim Lesson Levels & Prerequisites All classes are 30 minutes except where noted. Aqua-Tot: age 6 mos. 3 yrs. For infants/toddlers and their parent. The parent works directly with the child while the instructor provides supervision and guidance. The goal of this class is to introduce water adjustment skills in a safe and friendly environment. Blowing bubbles, floating, kicking, arm movement, entries and exits are some skills that may be covered. Swim diaper required and can be purchased at the pool. Pollywogs: age 3 5 yrs. Introductory swim course for children at least 24 inches shoulder height. This course works on water adjustment and fundamentals of swimming. Super Pollywogs: age 3 5 yrs. For children who have completed Pollywogs OR can front float, and swim 15 feet on stomach with assistance. This level continues the fundamentals with a more independent focus. Level 1 (Starfish): age 5 13 yrs. This is an introductory swim course designed to help students feel comfortable in the water. Students will learn basic fundamentals of floating, breath control and movement in the water. Level 2 (Lobster): age 5 13 yrs. Child must be able to demonstrate a front and back float. Students will learn to float without support and recovery as well as explore alternating arm and leg action on front and back. Level 3 (Seahorse): age 5 13 yrs. Child must be able to demonstrate front crawl (15 ft.) and back crawl (10 ft.) unsupported and be comfortable in deep water. Students will learn to coordinate front and back crawl. Elements of side breathing, butterfly, diving and treading water will be introduced. Level 4 (Seals): age 6 13 yrs. Child must be able to demonstrate front and back crawl (15 yds.), jump in and change direction in deep water unassisted, and tread water for 30 seconds. Students will increase their endurance in front and back crawl, build on butterfly, breaststroke and sidestroke. Level 5 (Shark): age 6 13 yrs. Child must be able to demonstrate front and back crawl (25 yds.), breaststroke, butterfly and elementary backstroke (15 yds.), tread water 1 minute, and swim underwater 3 body lengths. Students will refine their performance of all strokes and increase distances. Flip turns are also introduced. Level 6 (Dolphin): age 6 13 yrs. Students must be able to demonstrate front and back crawl (50 yds.), butterfly, breaststroke, side stroke and elementary backstroke (25 yds.), tread water 2 minutes and a shallow dive from side. The Complete Swimmer: ages 9-15 yrs. Refine strokes to improve technique, efficiency and power. This course is designed for swimmers interested in fitness, preparing for a competitive program or becoming a lifeguard. The instructor will teach using a variety of equipment and focus on endurance with a goal of swimming 500 yds. Students must have passed Level 4 or demonstrate equivalent skills. Private Lessons: age 3 years and up. Private lessons for adults & children are an excellent way to receive more individualized attention. Let our knowledgeable instructors customize each session to meet your needs, from the very basics of water adjustment to improving strokes for speed and efficiency. Private lessons are offered on first come first serve basis. For semi-private lessons, during scheduled private lesson times, please contact CAMP HOTLINE 522-SUMM or

3 Swim Class Information and Registration Helpful Hints Our swim lesson program is based on the American Red Cross Learn to Swim model. Lessons are taught by our enthusiastic, safety minded and caring staff and volunteers. All our instructors participate in on-going training and skills development. Registration NEW THIS YEAR! Starting on Tuesday, March 6th, at 9:00am, we will accept walk-in and internet registrations for all Aquatic Classes listed in this booklet. Registrations will not be accepted after the 3rd class meeting. Class information Participants must be the proper age and skill level on the first day of class. If a student does not meet the minimum requirements for age or ability, every effort will be made to transfer the student to a class at his/her level. If space is not available a transfer to a later session or refund will be offered. Children must be a minimum of 5 years old for Level 1-3 and 6 years old for Levels 4+. For the comfort and development of your child, adult lessons begin at age 13. Please read the level descriptions carefully and select the appropriate level for your child based on his/her current skills. It is not uncommon for a child to stay in a particular level several sessions before successful completion. Please make sure to check the location of the class on your receipt to make sure you are signed up in the facility you have requested. Children not potty trained and in diapers must wear a swim diaper during class. Swim diapers may be purchased at the pool. Appropriate swim attire is required. In an attempt to keep our pools running efficiently no street clothes are allowed in the pool at any time. Withdrawal/Refunds Class withdrawals with a refund will be allowed up to Friday at 4:00pm before the first day of the class. Classes may be canceled or consolidated with other classes, if enrollment does not meet minimums. Notification will be given within 24 hours of first class. Classes canceled by the City of San Mateo, will have a make-up date or credit issued. The City will determine the course of action for each occurrence. Classes missed for vacation, injury, illness or any other individual reason cannot be made up and are not eligible for credits or refunds. Recreation Fee Assistance Fee Program The Recreation Fee Assistance Program is designed to allow access to our programs for all residents. For those City of San Mateo residents with financial hardships, assistance is available to help offset the cost of swim lessons. Qualifying residents are currently eligible for 30% or 60% depending upon their current income. A current Enrollment Application accompanied by the required income documents is needed for program enrollment. Recreation Fee Assistance Enrollment Application is available at all Community Centers. Applications must be submitted as least 5 business days before the registration can be processed. (pending approval) Access Needs One of our key missions is to provide swim lessons for children with a wide range of abilities. If your child requires special accommodations, please indicate your modification request on the registration form. A member of our team will get back to you. We will make every effort to accommodate the needs of each child

4 Joinville Swim Center Morning Schedule MORNING SESSIONS Fee: $66 (Session 2: $58) SATURDAY Fee: $36 SESSION 1: 6/18-6/28 SESSION 2: 7/02-7/12 SESSION 3: 7/16-7/26 SESSION 4: 7/30-8/09 SESSION 1: 6/23-7/14 SESSION 2: 7/21-8/11 Barcode Time Barcode Time Barcode Time Barcode Time Barcode Time Barcode Time Aqua Tots J11 11:00 AM J21 11:00 AM J31 11:00 AM J41 11:00 AM J61 10:00 AM J71 10:00 AM Aqua Tots J62 11:00 AM J72 11:00 AM Aqua Tots J63 12:00 PM J73 12:00 PM Pollywogs J11 10:30 AM J21 10:30 AM J31 10:00 AM J41 10:30 AM J61 10:00 AM J71 10:00 AM Pollywogs J12 11:30 AM J22 11:00 AM J32 10:30 AM J42 11:00 AM J62 10:30AM J72 10:30 AM Pollywogs J13 12:00 PM J23 11:30 AM J33 11:00 AM J43 11:30 AM J63 11:30AM J73 11:30AM Pollywogs J24 12:00 PM J34 11:30 AM J74 12:00 PM Super Pollywogs J11 10:30 AM J21 10:00 AM J31 11:00 AM J41 10:00 AM Super Pollywogs J12 11:00 AM J22 11:00 AM J32 11:30 AM J42 10:30 AM J61 10:30 AM J71 10:30 AM Super Pollywogs J33 12:00 PM J43 12:00 PM J62 11:00 AM J72 11:00 AM Level One Starfish J11 10:00 AM J21 10:00 AM J31 10:00 AM J41 10:00 AM J61 10:00 AM J71 10:00 AM Level One Starfish J12 11:30 AM J22 10:30 AM J32 10:30 AM J42 10:30 AM J62 11:00 AM J72 11:00 AM Level One Starfish J23 11:30 AM J33 11:30 AM J43 12:00 PM J63 11:30 AM J73 11:30 AM Level One Starfish J64 12:00 PM J74 12:00 PM Level Two Lobster J11 10:00 AM J21 10:00 AM J31 10:00 AM J41 10:00 AM Level Two Lobster J12 12:00 PM J22 10:30 AM J32 10:30 AM J42 11:00 AM J61 10:30 AM J71 10:30 AM Level Two Lobster J23 11:30 AM J33 12:00 PM J62 11:00 AM J72 11:00 AM Level Two Lobster J24 12:00 PM J63 11:30 AM Level Three Seahorse J11 10:30 AM J21 10:30 AM J31 10:30 AM J41 11:00 AM J61 10:00 AM J71 10:00 AM Level Three Seahorse J12 11:00 AM J22 11:00 AM J32 11:00 AM J62 12:00 PM J72 11:30AM Level Four Seals J11 10:00 AM J21 10:00 AM J31 10:00 AM J41 10:00 AM J61 10:30 AM J71 10:30 AM Level Five Shark J41 11:30 AM CAMP HOTLINE 522-SUMM or

5 Joinville Swim Center Afternoon Schedule Fees: Afternoon $72 (Session 2: $63) Complete Swimmer $108 (Sesssion 2: $95) SESSION 1: 6/18-6/28 SESSION 2: 7/02-7/12 SESSION 3: 7/16-7/26 SESSION 4: 7/30-8/09 SESSION 5: 8/13-8/23 Barcode Time Barcode Time Barcode Time Barcode Time Barcode Time Aqua Tots J12 6:00 PM J22 6:00 PM J32 6:00 PM J42 6:00 PM J51 6:00 PM Pollywogs J14 4:30 PM J25 4:30 PM J35 4:30 PM J44 4:30 PM J51 4:30 PM Pollywogs J15 5:00 PM J26 5:00 PM J36 5:00 PM J45 5:30 PM J52 5:00 PM Pollywogs J16 5:30 PM J27 5:30 PM J37 5:30 PM J46 6:00 PM Pollywogs J17 6:00 PM J28 6:00 PM J38 6:00 PM J47 6:30 PM Pollywogs J39 6:30 PM Super Pollywogs J13 4:30 PM J23 4:30 PM J34 4:30 PM J44 5:00 PM J51 4:30 PM Super Pollywogs J14 5:00 PM J24 5:00 PM J35 5:30 PM J45 5:30 PM J52 5:30 PM Super Pollywogs J15 5:30 PM J25 5:30 PM J36 6:00 PM J46 6:30 PM Super Pollywogs J16 6:00 PM J37 6:30 PM Level One Starfish J13 4:30 PM J24 4:30 PM J34 4:30 PM J44 4:30 PM J51 4:30 PM Level One Starfish J14 5:00 PM J25 5:00 PM J35 5:00 PM J45 5:00 PM J52 5:30 PM Level One Starfish J15 5:30 PM J26 5:30 PM J36 6:00 PM J46 5:30 PM J53 6:00 PM Level One Starfish J16 6:30 PM J27 6:30 PM J37 7:00 PM J47 6:00 PM Level Two Lobster J13 4:30 PM J25 4:30 PM J34 4:30 PM J43 4:30 PM J51 5:00 PM Level Two Lobster J14 5:30 PM J26 5:30 PM J35 5:00 PM J44 5:00 PM J52 6:30 PM Level Two Lobster J15 6:00 PM J27 6:00 PM J36 5:30 PM J45 6:00 PM Level Two Lobster J16 6:30 PM J28 6:30 PM J37 6:30 PM J46 6:30 PM Level Three Seahorse J13 4:30 PM J23 4:30 PM J33 4:30 PM J42 5:00 PM J51 5:30 PM Level Three Seahorse J14 5:00 PM J24 5:00 PM J34 5:30 PM J43 5:30 PM J52 6:30 PM Level Three Seahorse J15 7:00 PM J25 6:00 PM J35 6:30 PM J44 7:00 PM Level Three Seahorse J26 7:00 PM Level Four Seals J12 5:00 PM J22 5:00 PM J32 5:00 PM J42 4:30 PM J51 6:00 PM Level Four Seals J13 5:30 PM J23 5:30 PM J33 5:30 PM J43 5:00 PM J52 7:00 PM Level Four Seals J14 7:00 PM J24 7:00 PM J44 7:00 PM Level Four Seals Level Five Shark J11 6:00 PM J21 6:00 PM J31 5:00 PM J42 4:30 PM J51 6:30 PM Level Five Shark J32 7:00 PM J43 6:00 PM Level Six Dolphin J11 6:30 PM J21 6:30 PM J31 6:00 PM J41 5:30 PM The Complete Swimmer J11 4:15 PM J21 4:15 PM J31 4:15 PM J41 4:15 PM

6 King Community Pool Morning Schedule Fees: $66 (Session 2 $58) / *45 minute classes - $ 99 (Session 2 - $86) SATURDAY Fee: $36 SESSION 1: 6/18-6/28 SESSION 2: 7/02-7/12 SESSION 3: 7/16-7/26 SESSION 4: 7/30-8/9 SESSION 1: 6/23-7/14 SESSION 2: 7/21-8/11 Barcode Time Barcode Time Barcode Time Barcode Time Barcode Time Barcode Time Aqua Tots K61 10:00 AM K71 10:00 AM Aqua Tots K11 11:30 AM K21 11:30 AM K31 11:30 AM K41 11:30 AM K62 11:30 AM K72 11:30 AM Pollywogs K61 10:00 AM K71 10:00 AM Pollywogs K62 11:00 AM K72 11:00 AM Pollywogs K11 11:00 AM K21 11:00 AM K31 11:00 AM K41 11:00 AM K63 11:30 AM K73 11:30 AM Pollywogs K64 12:00 PM Super Pollywogs K11 11:00AM K21 11:00 AM K31 11:00 AM K41 11:00 AM K61 10:00 AM K71 10:00 AM Super Pollywogs K62 11:00 AM K72 11:00 PM Super Pollywogs K73 12:00 PM Level One Starfish K11* 10:15 AM K21* 10:15 AM K31* 10:15 AM K61 10:30AM K71 10:30 AM Level One Starfish K62 11:30AM K72 11:30AM Level One Starfish K63 12:00 PM K73 12:00 PM Level Two Lobster K61 10:30AM K71 10:30 AM Level Two Lobster K11* 10:15 AM K21* 10:15 AM K31* 10:15 AM K41* 10:15 AM K62 12:00PM K72 12:00PM Level Three Seahorse K21* 10:15 AM K31* 10:15 AM K41* 10:15 AM K61 10:30AM K71 10:30 AM Level Four Seals K41* 10:15 AM K61 11:00 AM K71 11:00 AM CAMP HOTLINE 522-SUMM or

7 King Community Pool Afternoon Schedule 30 minute lessons Fee: $72 (Session 2: $63) SESSION 1: 6/18-6/28 SESSION 2: 7/02-7/12 SESSION 3: 7/16-7/26 SESSION 4: 7/30-8/9 Barcode Time Barcode Time Barcode Time Barcode Time Aqua Tots K12 6:00 PM K22 6:00 PM K32 6:00 PM K42 6:00 PM Pollywogs K12 4:30 PM K22 4:30 PM K32 4:30 PM K42 4:30 PM Pollywogs K13 5:00 PM K23 5:00 PM K33 5:00 PM K43 5:00 PM Pollywogs K14 5:30 PM K24 5:30 PM K34 5:30 PM K44 5:30 PM Pollywogs K15 6:00 PM K25 6:00 PM K35 6:00 PM K45 6:00 PM Pollywogs K16 6:30 PM K26 6:30 PM K46 6:30 PM Super Pollywogs K12 4:30 PM K22 4:30 PM K32 4:30 PM K42 4:30 PM Super Pollywogs K13 5:30 PM K23 5:30 PM K33 5:30 PM K43 5:30 PM Super Pollywogs K24 6:30 PM K34 6:30 PM K44 6:30 PM Level One Starfish K12 4:30 PM K22 4:30 PM K32 4:30 PM K41 4:30 PM Level One Starfish K13 5:00 PM K23 5:00 PM K33 5:00 PM K42 5:00 PM Level One Starfish K14 5:30 PM K24 5:30 PM K34 5:30 PM K43 5:30 PM Level One Starfish K15 6:00 PM K25 6:00 PM K35 6:00PM Level One Starfish K16 6:30 PM K36 6:30 PM K44 6:30 PM Level One Starfish K17 7:00 PM K26 7:00 PM K37 7:00 PM K45 7:00 PM Level Two Lobster K12 4:30 PM K22 4:30 PM K32 4:30 PM K42 4:30 PM Level Two Lobster K13 5:00 PM K23 5:00 PM K33 5:00 PM K43 5:00 PM Level Two Lobster K14 5:30 PM K24 5:30 PM K34 5:30 PM K44 5:30 PM Level Two Lobster K15 7:00 PM K25 7:00 PM K35 7:00 PM K45 6:00 PM Level Three Seahorse K11 4:30 PM K22 4:30 PM K32 4:30 PM K42 4:30 PM Level Three Seahorse K12 5:00 PM K23 5:00 PM K33 5:00 PM K43 5:00 PM Level Three Seahorse K13 6:30 PM K24 6:30 PM K34 6:00 PM K44 6:00 PM Level Three Seahorse K35 7:00 PM K45 7:00 PM Level Four Seals K11 6:00 PM K21 6:00 PM K31 6:00 PM K42 6:30 PM Level Five Shark K11 5:30 PM K21 5:30 PM K31 5:30 PM K41 5:30 PM Level Six Dolphin K11 7:00 PM K21 7:00 PM K31 6:30PM K41 6:00 PM

8 Private Swim Lessons: 3 years or older WEEK ONE: 6/18-6/21 WEEK TWO: 6/25-6/28 WEEK THREE: 7/2-7/5 (no class 7/4) WEEK FOUR: 7/9-7/12 WEEK FIVE: 7/16-7/19 Barcode Time Barcode Time Barcode Time Barcode Time Barcode Time Joinville Swim Center Fees: $132 (Week 3 - $99) Private J11 11:30am J110 11:30am J21 11:30am J210 11:30am J31 11:30am Private J12 12:00pm J111 12:00pm J22 12:00pm J211 12:00pm J32 12:00pm Private J13 6:30pm J112 6:30pm J23 6:30pm J212 6:30pm J33 6:30pm Private J14 6:30pm J113 6:30pm J24 7:00pm J213 7:00pm J34 7:00pm Private J15 7:00pm J114 7:00pm J25 7:00pm J214 7:00pm Private J16 7:00pm J115 7:00pm King Community Pool Fees: $132 (Week 3 - $99) Private K11 11:30am K110 11:30am K21 11:00am K210 11:00am K31 11:00am Private K12 12:00pm K111 12:00pm K22 11:30am K211 11:30am K32 11:30am Private K13 12:00pm K112 12:00pm K23 11:30am K212 11:30am K33 11:30am Private K24 12:00pm K213 12:00pm K34 12:00pm Private K25 12:00pm K214 12:00pm K-35 12:00pm Private K14 5:00pm K113 5:00pm K26 5:00pm K215 5:00pm K36 5:00pm Private K15 6:00pm K114 6:00pm K27 6:00pm K216 6:00pm K37 6:30pm Private K16 6:30pm K115 6:30pm K28 6:30pm K217 6:30pm K38 7:00pm Private K17 6:30pm K116 6:30pm K29 7:00pm K218 7:00pm Private K18 7:00pm K117 7:00pm K30 7:00pm K219 7:00pm WEEK SIX: 7/23-7/26 WEEK SEVEN: 7/30-8/2 WEEK EIGHT: 8/6-8/9 WEEK NINE and WEEK TEN SATURDAY Barcode Time Barcode Time Barcode Time Barcode Time Barcode Time Joinville Swim Center Fees: $132 Private J310 11:30am J41 10:30am J410 10:30am WEEK 9 8/13-8/16 SESSION 1 6/23-7/14 Private J42 11:30am J411 11:30am J51 5:00pm J61 11:30am Private J311 12:00pm J43 11:30am J412 11:30am J52 7:00pm J62 12:00pm Private J44 12:00pm J413 12:00pm Private J312 6:30pm J45 6:30pm J414 6:30pm WEEK 10 8/20-8/23 SESSION 2 7/21-8/11 Private J313 7:00pm J46 6:30pm J415 6:30pm J510 5:00pm J71 11:30am Private J47 7:00pm J416 7:00pm J511 7:00pm J72 12:00pm King Community Pool Fees: $132 Private K410 11:00am Private K310 11:00am K41 11:00am K411 11:30am Private K311 11:30am K42 11:30am K412 11:30am Private K312 11:30am K43 11:30am K413 12:00pm Private K313 12:00pm K44 12:00pm K414 12:00pm Private K314 12:00pm K45 12:00pm K415 5:00pm Private K315 5:00pm K46 5:00pm K416 6:30pm Private K316 6:30pm K47 6:30pm K417 7:00pm Private K317 7:00pm K48 7:00pm K418 7:00pm Private K49 7:00pm CAMP HOTLINE 522-SUMM or

9 * FREE* Staff Training Lessons *FREE* Saturday, June 16, 2018 Barcode Time Joinville Swim Center Aqua Tots J01 12:00pm Pollywogs J01 11:00am Super Pollywogs J01 11:30am Level One Starfish J01 11:00am Level Two Lobster J01 11:30am Level Three Seahorse J01 12:00pm Saturday, June 16, 2018 Barcode Time King Community Pool Aqua Tots K01 12:00pm Pollywogs K01 11:00am Super Pollywogs K01 11:30am Level One Starfish K01 11:00am Level Two Lobster K01 11:30am Level Three Seahorse K01 12:00pm Half hour swim lessons to give our staff a chance to practice teaching lessons. Recreation Swim Schedule 2018 Joinville Swim Center 2111 Kehoe Ave., San Mateo (650) King Swim Center 725 Monte Diablo, San Mateo (650) June 18- August 15 M-F 1:00-4:00pm June 18- August 10 M-F 1:00-4:00pm June 16-September 2 Sa/Su 1:00-5:00pm June 16-August 12 Sa/Su 1:00-5:00pm Holiday Swim Hours July 4, September 3 1:00-5:00pm A 15 minute break will occur each day from 2:45-3:00pm at both locations FEES Daily Drop In Pass (Valid 6/16-9/3, 2018)* Youth (0-15yrs) $ Punch Pass $32.50 Adult (16yrs+) $ Punch Pass $47.50 Family (max 6 members) Season Pass $150 Celebrate that special event at Joinville Pool! Kids of all ages can celebrate birthdays or special occasions with a pool party. Reserve your spot today with a $90 non-refundable deposit for up to 15 guests. Invite up to 5 more guests for an additional $6.00 per person. Parties are booked on a first come first served basis, Saturdays and Sundays June 23 - August 19, Price includes admission to recreation swim 1:00-5:00 pm, reserved picnic area and 45 minutes of Lifeguard led fun and games for your group at Joinville Pool. We will start taking reservations June 4th. Please call for more information. Please note children age 5 and under must be accompanied by an adult in the water, -1 adult per child at all times. *No Rec Swim at Joinville on Wednesday, 7/18 for City event *Summer Family Fun Day Saturday, 7/21 Child $4 and Adult $6 Jr. Guards: age yrs. Be a Water Safety Swim Aide Join The Team as a volunteer Swim Lesson Aide with the City of San Mateo Aquatics program. It s a great way to help others learn to swim while earning school or community service hours. By assisting our Swim Instructors with teaching swimming and water safety skills, you learn valuable job skills while having fun with your friends at Joinville or King Pool. Swim Aides are required to complete the Swim Instructor Aide Course (Classes offered in the Summer Guide) and volunteer for at least one 2-week session mid-june through mid-august. For more information and an application, call before June 15 or starting June

10 City of San Mateo Parks & Recreation Department Activity Registration Form Resident* Nonresident Parent/Guardian Date of Birth (must be 18 yrs. or older) or Adult Registrant Home Address City Zip Home Ph. Cell Ph. Address Emergency Contact Home Ph. Cell Ph. Participant Name Date of Birth Gender Activity Code Activity Fee TOTAL $ WAIVER OF LIABILITY & PHOTO RELEASE: In consideration of participation in the City of San Mateo recreation program described above (the Activity ), I the undersigned for myself and/or as the parent/guardian of the Minor named above, agree to indemnify and hold the City of San Mateo, it s elected and appointed officials, employees, and agents (the City ) harmless and hereby waive, release and discharge any and all claims for damage, for death, personal injury, bodily injury or property damage which I and/or the Minor may have or which hereinafter may accrue to me and/or the Minor against the City from and against any liability arising out of or connected in any way with my and/or the Minor s participation in this Activity, even though that liability may arise out of negligence or carelessness on the part of the person or entities mentioned above. I understand that accidents and injuries can arise from participation in this class or activity; knowing the risks, nevertheless, I hereby agree to assume those risks on behalf of me and/or the above named Minor and to release and to hold harmless all of the persons or entities mentioned above whom (though negligence or carelessness) might otherwise be liable to me and/or the above named Minor (or my/our heirs or assignees) for damages. It is further understood and agreed that this waiver, release and assumption or risks has been freely entered into and is to be binding on my/our heirs and assigns. I have read and agree to the registration and program policies. Further, I agree to allow use of my image and/or that of the named minor, which may be captured through video, photo, digital camera or other media, for City of San Mateo promotional materials and publications. By my signature below, I acknowledge that I have read this document and understand its contents. Check the appropriate space(es) and sign: Participant (over 18) Parent Legal Guardian Print Name of Participant: Signature Required: Parent/Guardian, if under 18: Class/Program Modification Request: We encourage and support the participation of individuals with all ability levels in programs and services. This includes those with disabilities, and in need of reasonable program modifications in order to participate. Please complete the statement: I am requesting a reasonable program modification for the class/program(s) listed on this registration form. Yes No Participants Name Date: Check Enclosed: Total Amount $ Make Check Payable to: City of San Mateo Card Number CRV Code Exp Total Amount $ Card Holder Signature Enroll now: