Community Activity Guide Spring 2022 Willow Glen Community Center by San José Parks, Recreation and Neighborhood Services Community Center Brochures

WILLOW GLEN

COMMUNITY CENTER 2175 Lincoln Avenue (408) 448-6400

G N 2 I 0 R 22 P S

PROGRAMS FOR ALL AGES SCHOLARSHIP DETAILS INSIDE!

www.sanjoseca.gov/prns | www.sjregistration.com

YOUR COMMUNITY. YOUR BROCHURE. INCLUSION POLICY The City of San José, Department of Parks, Recreation and Neighborhood Services (PRNS) encourages and supports the participation of individuals with all ability levels in programs and services. To facilitate opportunities for people with and without disabilities and to engage in leisure pursuits together, PRNS provides inclusion support services. These services include, but are not limited to interpreters for the deaf or hearing consideration of the requested accommodation, is provided at least two weeks in advance. For more information on inclusion opportunities, specialized recreation services and accommodations, please contact Therapeutic Services at 408.369.6438. San José 311 enables you and City crews to more quickly connect in keeping our city well maintained! Download the free App today!

SCHOLARSHIPS APPLY AT YOUR LOCAL COMMUNITY CENTER! preschool programs | afterschool programs | youth enrichment classes | adult classes | therapeutic programs

Scholarships are awarded as funding is available. Completion of the scholarship application does not guarantee approval of a scholarship.

WILLOW GLEN

COMMUNITY CENTER 2175 Lincoln Avenue (408) 448-6400

THREE EASY WAYS TO REGISTER 1. Visit us online at www.sanjoseca.gov/prns 2. Walk into your local community center and register with the front desk 3. Mail or fax to your local community center

COMMUNITY CENTER AND CITY LOCATIONS ALMA COMMUNITY CENTER 136 W. ALMA AVE. 408-275-1315 / 408-294-0478 (FAX) BUS LINE: 82 / DISTRICT 7

ALMADEN COMMUNITY CENTER 6445 CAMDEN AVE. 95120 408-268-1133 / 408-997-1222 (FAX) BUS LINE: 63 / DISTRICT 10

BASCOM COMMUNITY CENTER 1000 S. BASCOM AVE. 95128 408-794-6289 / 408-280-5030 (FAX) BUS LINE: 62 / DISTRICT 6

BERRYESSA COMMUNITY CENTER 3050 BERRYESSA RD. 95132 408-251-6392 / 408-251-7687 (FAX) BUS LINE: 62 / DISTRICT 4

CAMDEN COMMUNITY CENTER 3369 UNION AVE. 408-559-8553 / 408-559-1203 (FAX) BUS LINE: 37 & 62 / DISTRICT 9

CYPRESS COMMUNITY & SENIOR CENTER

EMMA PRUSH FARM PARK 647 S. KING D. 95122 408-794-6262 / 408-926-9181 (FAX) BUS LINE: 22, 25, & 77 / AGRICULTURE HERITAGE

EVERGREEN COMMUNITY CENTER 4860 SAN FELIPE RD. 95135 408-270-2220 / 408-223-6063 (FAX) BUS LINE: 31, 39 & 42 / DISTRICT 8

GARDNER COMMUNITY CENTER 520 W. VIRGINIA ST. 95125 408-277-2474 / 408-277-4640 (FAX) BUS LINE: 64 & LIGHT RAIL / DISTRICT 6

GRACE COMMUNITY CENTER 488 N. 6TH ST. 95112 408-293-0422 / 408-277-2474 (FAX) BUS LINE: 64A, 64B, 66

HANK LOPEZ COMMUNITY CENTER 1694 ADRIAN WY. 95122 408-794-1630 / 408-923-5215 (FAX) BUS LINE: 70 / DISTRICT 5

MAYFAIR COMMUNITY CENTER 2039 KAMMERER AVE. 95116 408-794-1060 / 408-347-9732 (FAX) BUS LINE: 22 & 77 / DISTRICT 5

MILLBROOK COMMUNITY CENTER 3200 MILLBROOK DR. 408-274-1343 BUS LINE: 30 & 31 / DISTRICT 8

ROOSEVELT COMMUNITY CENTER 901 E. SANTA CLARA ST. 95116 408-794-7555 / 408-294-7981 (FAX) BUS LINE: 22 & 64 / DISTRICT 3

SEVEN TREES COMMUNITY CENTER 3590 CAS DR. 95111 408-794-1690 / 408-972-2175 (FAX) BUS LINE: 66, 68 & 73 / DISTRICT 7

SOUTHSIDE COMMUNITY & SENIOR CENTER 5585 COTTLE RD 408-629-3336 BUS LINE:

WILLOW GLEN COMMUNITY & SENIOR CENTER 2175 LINCOLN AVE. 95125 408-448-6400 / 408-978-8291 (FAX) BUS LINE: 26 & 64 / DISTRICT 6

MAIN PRNS OFFICE 200 E. SANTA CLARA ST. 408-535-3570 / 408-292-6299 DOWNTOWN SAN JOSE

403 CYPRESS AVE. 95117 408-244-1353 / 408-249-9460 (FAX) BUS LINE: 62 / DISTRICT 1

DO YOU NEED ASSITANCE WITH ONLINE REGISTRATION? CONTACT THE RECS ONLINE HELP DESK

(408) 793-5565

SJREGISTRATION@SANJOSECA.GOV

SAN JOSE

PARKS, RECREATION & NEIGHBORHOOD SERVICES

Building Community Through Fun

WHATS INSIDE SPRING 2022

REGISTRATION & SCHOLARSHIP

ALL ACCESS RECREATION

WILLOW GLEN PRESCHOOL

KIRK PRESCHOOL

R.O.C.K AFTERSCHOOL PROGRAM

WILLOW GLEN TEEN CENTER

ALMA TEEN CENTER

YOUTH DANCE & SPORTS

YOUTH SPORTS

11-12 CAMP SAN JOSE JR. (AGE 3-5) 13

CAMP SAN JOSE (AGE 5-12)

F.I.T. CAMP

YOUTH SPECIALTY CAMPS

YOUTH SPORTS CAMPS

ACTIVE ADULTS: FITNESS

ACTIVE ADULTS: ARTS & SOCIAL

PROGRAMS & SERVICES

PHONE NUMBER (408) 448-6400

WEBSITE PAGE sanjoseca.gov/prns

HOURS OF OPERATION Monday 9 a.m. - 6 p.m. Tuesday 9 a.m. - 6 p.m. Wednesday 9 a.m. - 6 p.m. Thursday 9 a.m. - 6 p.m. Friday 9 a.m. - 6 p.m. Saturday 9 a.m. - 1:30 p.m. *Center hours will vary depending on activity.

STAFF Tiffany Dong - Recreation Supervisor tiffany.dong@sanjoseca.gov Esther Aguirre - Recreation Specialist esther.aguirre@sanjoseca.gov Jaclyn Torres - Recreation Specialist jaclyn.torres@sanjoseca.gov

Gabriel Nuanez - Recreation Specialist gabriel.nuanez@sanjoseca.gov Sylvia Torres - Recreation Specialist sylvia.torres@sanjoseca.gov

CITY HOLIDAY CLOSURES New Year's Day

1/01/2022

MLK Day

1/20/2022

FIND US ON www.yelp.com/biz/willow-glencommunity-center-san-jose-2

www.facebook.com/Willow GlenCCSJ

REGISTRATION SPRING CLASSES

FEB. 26, 2022 10 A.M. REGISTER AT ANY CITY OF SAN JOSE COMMUNITY CENTER OR ONLINE! WWW.SJREGISTRATION.COM

SCHOLARSHIPS Did you know that PRNS offers a variety of scholarship opportunities to those individuals and families in need? Whether you are looking for a preschool program, after school program, youth enrichment class, summer camp, adult class, or therapeutic program, PRNS is committed to providing access to our recreation programs.

The scholarship application is available to download at sanjoseca.gov/scholarships or you can inquire at your local community center.

ACTIVATESJ QUALITY PLACES

QUALITY CONNECTIONS

QUALITY TIME www.activatesj.com

ALL ACCESS SPORTS & RECREATION Specialized Programs All Access Sports and Recreation (AASR) provides a wide range of programs for individuals of all ages will all ability levels including those with ambulatory or cognitive disabilities, such as power soccer, cooperative dances, play camps and groups arts. for more information check out our website at http://sanjoseca.gov/therapeutics

Inclusion:

We welcome people of all abilities and all ages to participate in our programs! if you or your child has a disability, behavior concern, severe allergy, or other condition requiring accommodation, please let us know know at the time of registration. Please register early to allow adequate time to process requests. Requests can take up to two weeks to process. Inclusion describes an approach wherein participants with special needs spend most or all of their time with people who are non disabled peers. Please see our inclusion policy for more information about our inclusion support services.

SAN JOSE RECREATION PRESCHOOL DISCOVER

LEARN

PLAY

SJ Rec Preschool Spanish Exploration @ Willow Glen - Room 10 This class introduces your child to the Spanish language as they prepare for kindergarten through age-appropriate activities, learning concepts, socialization skills, and fun. Your child will gain a basic understanding of Spanish words, shapes, colors, pre-phonics, literacy building (i.e. identifying letter sounds, writing the alphabet and simple words), number recognition, and counting up to 30 in both English and Spanish. The goal is to have fun, participate, and learn. Children must be able to use the restroom unassisted, Children also must be able to wear a face mask for the duration of each class. All children must have valid immunization records on file before the start of class. Requirements for parent participation will vary by center.

Course Number

Time

Date

Days

Age

Session

Instructor

233.5.0001 @ Willow Glen

9:30 a.m. 12:30 p.m.

8/30-9/18

M-Th

3-5

Ms. Evelyn Ms. Lisa

233.5.0002 @ Willow Glen

9:30 a.m. 12:30 p.m.

9/29-3/3

M-Th

3-5

Ms. Evelyn Ms. Lisa

233.5.0003 @ Willow Glen

9:30 a.m. 12:30 p.m.

3/14-6/2

M-Th

3-5

Ms. Evelyn Ms. Lisa

SAN JOSE RECREATION PRESCHOOL DISCOVER

LEARN

PLAY

SJ Recreation Preschool @ Kirk Community Center - Room 2 This class prepares your child for kindergarten with age-appropriate activities, learning concepts, socialization skills, and fun. Your child will gain a basic understanding of shapes, colors, pre-phonics, literacy building (i.e. identifying letter sounds, writing the alphabet and simple words), number recognition, and counting up to 30. The goal is to have fun, participate, and learn. Children must be able to use the restroom unassisted, Children also must be able to wear a face mask for the duration of each class. All children must have valid immunization records on file before the start of class. Requirements for parent participation will vary by center.

Course Number

Time

Date

Day

Age

Session

Instructor

233.5.0011 @ Kirk

9:00 a.m. 12:00 p.m.

8/30-9/18

M-Th

3-5

Ms. Bella Ms. Lilly

233.5.0012 @ Kirk

9:00 a.m. 12:00 p.m.

9/29-3/3

M-Th

3-5

Ms. Bella Ms. Lilly

233.5.1113 @ Kirk

9:00 a.m. 12:00 p.m.

3/14-6/2

M-Th

3-5

Ms. Bella Ms. Lilly

THE RECREATION OF CITY KIDS (R.O.C.K.) AFTERSCHOOL PROGRAM OFFERS A Safe And Nurturing Environment Homework Assistance | Enrichments Recreation & STEAM (Science, Technology, Engineering, Art, and Math) Activities LOCATIONS Gardner Elementary School Reed Elementary Schallenberger Elementary Willow Glen Community Center

DATES AND TIMES Mondays-Fridays (except school holidays, breaks, and inservice days), from when the bell rings until 6 p.m.

PAYMENT OPTIONS $165 Punch Pass for 10 visits $2,451 one time payment $817 quarterly auto pay (Sept, Nov, Feb) $272.33 monthly auto pay (requires a credit card)

REGISTRATION

Registration opens Saturday, July 17, @ 10 a.m. Online at SJRegistration.com In person at the Community Center Registration will not be accepted at the school office

SCHOLARSHIPS

Scholarships are awarded as funding is available. Completion of the scholarship application does not guarantee approval of a scholarship.

FOR MORE INFORMATION

Willow Glen Community Center 2175 Lincoln Ave, San Jose 95125 (408) 448-6400 Esther.Aguirre@sanjoseca.gov

R.O.C.K. Afterschool is a license-exempt program

WILLOW GLEN TEEN CENTER AGES 13-17

The City of San José Teen Centers

Under CDC safety measures, provides teens with a safe space to socialize, and participate in physical activity, healthy and fun recreation, enrichment activities, and a quiet place to receive homework assistance.

Services we offer Activities Crafts Music Video Games Sports Clubs Field Trips & Events

Hours of Operation Monday-Friday 2:00 p.m.- 6:00 p.m.

https://bit.ly/sjprns-teencenters

ALMA TEEN CENTER AGES 13-17

The City of San José Teen Centers

Services we offer Activities Crafts Music Video Games Sports Clubs Field Trips & Events

Hours of Operation Monday-Friday 2:00 p.m. - 6:00 p.m. Wednesday 12:45 p.m. - 6:00 p.m.

https://bit.ly/sjprns-teencenters

DANCE & SPORTS

SPRING CLASSES BALLET / TAP

FIRST TOUCH FUTSAL

Instructor: Dance Arts Academy (Multi Purpose Room)

Instructor: Futsal Kingz (Lincoln Glen Park)

Come join the fun! Students will have fun learning Ballet positions, warm-ups, and tap steps. Correct technique and terms will be taught. Students will learn a dance routine to perform for family and friends. Wear dance attire and bring tap and ballet shoes. Parents are allowed to stay for the first 10 minutes on the first day of class and are encouraged to attend the last class for a presentation.

Course #

Time

Date

233.4.0201 3:30pm-4:25pm

03/30-05/18

Day

Age Mtg. Res.

Wed. 3-8.

$102

A great beginner gymnastic class teaching basic gymnastic skills, including movement exploration, balance, and coordination, and at the same time teaching agility and improving motor skills.

Instructor: Dance Arts Academy (Multi Purpose Room) Time

233.3.0845 4:30pm-5:25pm

Course #

Time

Date

233.4.0846 9:35am-10:10am 04/09-06/04

Day

Age Mtg. Res.

Sat.

3-5.

$168

FUTSAL AGES 5-6

MINI GYM STARS

Course #

Futsal is a fun, fast-paced 5v5 soccer game, played indoors within the lines of a basketball court (no walls), using a small, size 3, low-bounce ball. In this class players participate in fun educational games. Classes focus on increasing balance, coordination and fundamental futsal skills. We utilize creative fun activities to help kids to cooperate in a group setting and build self esteem in our fun low-pressure environment.

Date

Day

03/30-05/18

Wed.

Age Mtg. Res. 8 $102 3-8.

Futsal is a fun, fast-paced 5v5 soccer game, using a small, size 3, low-bounce ball. During this class players participate in fun educational games. Every player has a ball at their feet and get the opportunity to put their skills to the test in a fun scrimmage. Shin guards are required.

Instructor: Futsal Kingz (Lincoln Glen Park) Course #

Time

233.4.0847 10:10am-11:00am

Date 04/09-06/04

Day

Age Mtg.

Res.

Sat.

5-6.

$168

FUTSAL AGES 7-12 Futsal is a fun, fast-paced 5v5 soccer game, using a small, size 3, low-bounce ball. Players will learn new skills & tricks every week from our professional coaching staff and have a great experience, whether they're the next Beckham or trying Futsal for the first time! Shin guards are required.

Instructor: Futsal Kingz (Lincoln Glen Park)

WILLOW GLEN CHILDREN'S THEATER Give your child the chance to act on stage! Kids participate in the entire process of creating an original play, from the first spark of an idea to the final moment of taking a bow on stage. The workshop draws children in right from the start with theatre games and improvised scenes. Our unique approach will teach your child tools that they can apply to their everyday life and will help them make new friends through the magic of theatre. Additional weekday rehearsals will begin prior to performance date.

Course #

Time

Date

Day

233.4.0848 11:00am-12:00pm 04/09-06/04 Sat.

*Weekday rehearsals will begin March 22nd, meeting every Tuesday & Thursday. * Performance dates will be April 29th, 30th, & May 1st, time TBD.

Instructor: WGCT Staff (Multi Purpose Room) Course # Time Day Age Mtg. Res. Date 233.3.0602 10:00am-12:00pm 02/05-05/01 Varies 7-18 21 $185 4:00pm-6:00pm

Age Mtg.

Res.

7-12.

$168

SPORTS

SPRING CLASSES TOT/PRE-SOCCER

SOCCER 1 (AGES 5-6)

Little tykes will enjoy running and kicking just like the big kids! Learn core soccer skills through our energetic, all-inclusive games. In addition to soccer skills, we develop good sportsmanship and a lifelong love of soccer. All participants receive a Kidz Love Soccer jersey! Shin guards are required after the first meeting.

Soccer 1: Techniques & Teamwork (Ages 5-6)

Class Hotline: 1-888-372-5803

Instructor: Kidz Love Soccer (Lincoln Glen Park) Course #

Time

Date

Day

Age Mtg.

233.4.0850 4:35pm-5:10pm 04/04-05/16 Mon. 3.5-5 233.4.0854 5:20pm-5:55pm 04/07-05/19 Thu. 3.5-5

7 7

Res. $148 $148

Players will learn dribbling, passing, defense and shooting goals! Fun, skill games are played at every session, and every participant will have a ball at his or her feet. Perfect for first time players while being fun and engaging for kids with some experience. All participants receive a soccer jersey! Shin guards are required after the first meeting. Class Hotline: 1-888-372-5803

Instructor: Kidz Love Soccer (Lincoln Glen Park) Course #

Time

Date

Day

233.4.0849 3:45pm-4:30pm 04/04-05/16 Mon. 233.4.0852 3:40pm-4:25pm 04/07-05/19 Thu.

MOMMY/DADDY & ME

As you and your child participate in our fun age appropriate activities, your child will be developing their large motor skills and socialization skills. The fun happens on the field, and parents are a part of the action! All kids receive a Kidz Love Soccer jersey! Class Status Hotline: 1-888-372-5803

Instructor: Kidz Love Soccer (Lincoln Glen Park) Course #

Time

Date

233.4.0851 5:15pm-5:45pm 04/04-05/16 233.4.0855 6:05pm-6:35pm 04/07-05/19

Day

Age Mtg.

Res.

Mon. Thu.

2-3 2-3

$148 $148

7 7

Age Mtg.

Res.

5-6 5-6

$148 $148

7 7

SOCCER 2 (AGES 7-10) Soccer 2: Skillz & Scrimmages (Ages 7-10) Kidz will enjoy advanced skill building: dribbling, passing, shooting and more in a team format. This class teaches individual skills and team play with lots of fun and action! All skill levels are welcome. All participants receive a Kidz Love Soccer jersey! Shin guards are required. Class Status Hotline: 1-888-372-5803

Instructor: Kidz Love Soccer (Lincoln Glen Park) Course #

Time

233.4.0853

4:30pm-5:15pm

Date

Day

04/07-05/19 Thu.

Age Mtg.

Res.

7-10

$148

2022 CAMP SAN JOSE JR.

REGISTRATION BEGINS, FEBRUARY 26, 2022 FOR SCHOLARSHIP ELIGIBLE FAMILIES

GENERAL REGISTRATION STARTS MARCH 10, 2022 At Camp San Jose Jr., your child will participate in an unforgettable summer camp! We combine camp traditions with a wide variety of enrichment and educational activities. Children will have the opportunity to create cool art projects, play games and, sing funny songs while ensuring CDC safety measures. Camp San Jose Jr. includes skill building, making new friendships, and much more! Campers need to bring water, lunch and sunscreen each day. Each Camp San Jose Jr. session runs for one (1) week. Safety is our main priority and we will continue to follow all Santa Clara County and state of California guidelines. Staff will conduct health screenings and wellness checks with each camper daily. All camp staff and participants will be required to wear face coverings.

SESSIONS RUN June 13 - August 5

WEEKLY COST $150 $131 for Juneteenth Week & 4th of July week

For questions, please email sjregistration@sanjoseca.gov.

CONVENIENT LOCATIONS All throughout San Jose

PROGRAM HOURS 3 hours, Monday - Friday

Scholarships are awarded as funding is available. Completion of the scholarship application does not guarantee approval of a scholarship. To request an accommodation for City-sponsored events or an alternative format for printed materials, please contact Nancy Doan at 408-513-3342 or (800) 735-2922 (TTY) as soon as possible, but at least three business days before the event. Para más información: nancy.doan@sanjoseca.gov. Để biết thêm thông tin, xin vui lòng liên nancy.doan@sanjoseca.gov. License Exempt.

CAMP SAN JOSE JR. WILLOW GLEN & KIRK (AGE 3-5) At Camp San Jose Jr. your child will participate in an unforgettable summer camp! We combine camp traditions with a wide variety of enrichment and educational activities. Children will have the opportunity to create cool art projects, play games and, sing funny songs while ensuring CDC safety measures. Camp includes skill building, new friendships, and much more! Campers need to bring water, lunch and sunscreen each day. Each Camp San Jose Jr. session runs for one (1) week Scholarship registration begins Saturday, February 26. Scholarships are available, see the following page for details and deadlines. Online registration, SJRegistration.com, begins on Saturday, March 10.

Week

Willow Glen Community Room 10 Center Course #

Kirk Community Center - Room 2 Course #

Date

233.1.1018

233.1.1027

6/13-6/17

233.1.1019

233.1.1028

6/21-6/24

233.1.1020

233.1.1029

6/27-7/1

233.1.1021

233.1.1030

7/5-7/8

233.1.1022

233.1.1031

7/11-7/15

233.1.1023

233.1.1032

7/18-7/22

233.1.1024

233.1.1033

7/25-7/29

233.1.1025

233.1.1034

8/1-8/5

SJRegistration.com

SUMMER 2022 SCHOLARSHIP REGISTRATION BEGINS FEB 26

GENERAL REGISTRATION OPENS MARCH 10

FLEXIBLE PAYMENT PLANS

CONVENIENT LOCATIONS

FULL DAY OF PROGRAM

ENRICHMENT ACTIVITIES

RESERVE YOUR SPOT FOR AS LOW AS $50

ALL THROUGHOUT SAN JOSE

8 A.M. - 6 P.M. MONDAY - FRIDAY*

LEARN WHILE HAVING FUN

At Camp San Jose, your child will participate in an unforgettable camp experience combining camp traditions with enriching and educational activities. The campers will participate in games, sports, create cool arts and crafts projects, and sing funny songs while ensuring CDC safety measures.* Price includes a low leader to child ratio of 1:10, field trips, a Camp San Jose shirt, skill building, new friendships, learning projects, and much more! Campers need to bring water, lunch and sunscreen each day. Check with your local community center for a complete list of field trips, lunch programs, scholarships and payment plans. Each Camp San Jose session runs for one week. *Safety is our main priority and we will continue to follow all Santa Clara County and state of California guidelines. Trained leaders will conduct health screenings and wellness checks with each camper daily. All camp staff and participants will be required to wear face coverings.

CAMP SAN JOSE SESSION: $263 SESSIONS STARTING ON JUNE 13 FOURTH OF JULY SESSION: $232 JUNETEENTH SESSION: $232

Sign up at sjregistration.com Scholarships are available for those who qualify; awarded as funding is available. Please contact your local Community Center for more info.

For any questions, email sjregistration@sanjoseca.gov

SUMMER 2022 SCHOLARSHIP REGISTRATION BEGINS FEB 26

GENERAL REGISTRATION OPENS MARCH 10

FLEXIBLE PAYMENT PLANS

CONVENIENT LOCATIONS

PROGRAM HOURS

ENRICHMENT ACTIVITIES

RESERVE YOUR SPOT FOR AS LOW AS $50

ALL THROUGHOUT SAN JOSE

9 A.M. - 3 P.M. MONDAY - FRIDAY*

LEARN WHILE HAVING FUN

Get outdoors and have some fun. F.I.T. Camp offers fitness activities, fitness enrichment, fun interactive games, and healthy cooking club. Sign up today! At F.I.T. Camp, your kids will build friendships, gain confidence, enjoy outdoor activities and attend field trips! They will develop a balanced approach to being physically active for a lifetime! Campers will learn healthy habits through the use of an evidence-based curriculum ensuring CDC safety measures*. Price includes a low leader to child ratio of 1:10, field trips, a F.I.T. Camp shirt, skill building, new friendships, learning projects and much more! Get F.I.T. this summer! Campers need to bring water, lunch and sunscreen each day. Check with your local community center for a complete list of field trips, lunch programs, scholarships and payment plans. Each F.I.T. Camp session runs for 1 week. *Safety is our main priority and we will continue to follow all Santa Clara County and state of California guidelines. Trained leaders will conduct health screenings and wellness checks with each camper daily. All camp staff and participants will be required to wear face coverings.

F.I.T. CAMP SESSION: $180 SESSION STARTING ON JUNE 13 JUNETEENTH WEEK: $158 FOURTH OF JULY WEEK: $158

Sign up at sjregistration.com Scholarships are available for those who qualify; awarded as funding is available. Please contact your local Community Center for more information

For any questions, email sjregistration@sanjoseca.gov

SUMMER CAMPS

SPECIALTY CAMPS

CAMP DANCE @ WILLOW GLEN

STEM-ULATING SCIENCE CAMP

A little bit of everything! Ballet, Tap, Jazz, Hip-Hop, Gymnastics, Cheer, Singing, and Hawaiian are all taught in this great half-day camp. Participants are placed in age-appropriate classes. A snack and juice is provided. Great recital for parents on Friday!

Find out just how much fun Science, Technology, Engineering and Math (STEM) can be with our unique and exciting hands-on activities! We put our engineering and technology skills to use and build structures, explore space and discover magnetic levitation! Basic math concepts such as units of measure, shapes, problem solving, addition and subtraction are used during our crazy experiments! Kids will continue the fun and learning at home with experiments they’ve made at camp!

Instructor: Dance Arts Academy Course #

Time

Date

Day

Age Mtg.

233.1.0202 9:00am-12:00pm 06/27-07/01 Mon- 512 Fri

Res. $137

YOUNG INVENTORS CAMP Creative Contraption Warning! This Mad Science camp is designed by you—the Inventor! Each day you’ll be given a series of challenges which must be overcome using basic materials, simple machines, tips from world famous inventors and the most important thing of all – your imagination! With a little bit of ingenuity, you’ll construct catapults and forts, then lay siege to the castle. Assemble your own working light stick and prepare to rule the galaxy! While Thomas Edison said, invention is 10% inspiration and 90% perspiration; this camp is 100% fun!

Instructor: Mad Science of Bay Area Course #

Time

233.1.0701

1:00pm-4:00pm

Date 06/27-07/01

Day

Age Mtg.

Res.

MonFri.

7-12

$283

Instructor: Mad Science of Bay Area Course #

Time

233.1.0703

1:00pm-4:00pm

Date 07/11-7/15

Date

Day

Age Mtg.

Res.

6-11

$230

Res. $283

Instructor: Mad Science of Bay Area Course #

Time

Date

Day

Age Mtg.

233.1.0704 9:00am-12:00pm 07/18-07/22 Mon- 4-6 Fri.

Instructor: Mad Science of Bay Area Time

LITTLE GREEN THUMBS

From decoding messages to metal detectors and night vision, campers check out spy tech equipment and take-home lots of gadgets! Step into the shoes of a detective as you uncover the science involved in evidence gathering and analysis! Figure out the science of forensics and reveal who is behind those crazy capers! Become a super spy and learn clever ways of performing tasks as we take a hands-on view of the science that spies use! Course #

Age Mtg.

Flowers and minds can’t blossom without STEMs. This camp is specially designed for inquisitive pre-K or Kinder-“Gardeners”. Kids discover how to paint with wind, build a bug model, start their own garden and learn what nature needs to make their plants grow! Non-stop activities keep your little Mad Scientists engaged and focused! Kids give it two Green Thumbs up!

SPY ACADEMY CAMP

233.1.0702 9:00am-12:00pm 07/05-07/08 TueFri.

Day

Mon- 4-6 Fri.

Res. $283

SUMMER CAMPS

SPORTS CAMPS

FUTSAL CAMP (HALF-DAY)

SOCCER CAMP LEVEL 1

Futsal is a fun, fast-paced 5v5 soccer game, , using a small, size 3, low-bounce ball. This week long futsal camp is fantastic way to get into the game whether you are trying futsal for the first time or are the next Beckham! Our highly trained professional coaching staff will ensure that your child will improve their technical skills and level of play all while having a great time. All participants will receive a Futsal Kingz T-Shirt. Shin guards are required.

Spend a week enjoying the world’s most popular sport in a fun, recreational environment. Learn and practice soccer skills including: dribbling, passing, receiving, shooting and defense. Everyone is a winner as the week’s fun culminates in an ageappropriate “World Cup” tournament. All campers will receive a soccer jersey. Campers should bring a full water bottle and a snack. All participants must wear shin guards; soccer shoes and sunscreen are recommended.

Instructor: Futsal Kingz (Lincoln Glen Park)

Instructor: Kidz Love Soccer (Lincoln Glen Park)

Course #

Time

Date

Day

233.1.0871 9:00am-12:00pm 06/21-06/24 233.1.0873 9:00am-12:00pm 07/11-07/14 233.1.0875 9:00am-12:00pm 08/08-08/12

Age Mtg.

Mon- 6-12 Fri.

4 5 5

Res.

Course #

$200 $250 $250

233.1.1036 9:00am-12:00pm 06/27-07/01 233.1.1039 9:00am-12:00pm 07/18-07/22

Instructor: Futsal Kingz (Lincoln Glen Park) Time

Date

233.1.0872 9:00am-3:00pm 233.1.0874 9:00am-3:00pm 233.1.0876 9:00am-3:00pm

06/21-06/24 07/11-07/14 08/08-08/12

Date

Day

Age Mtg.

Mon- 4.5-6 Fri.

5 5

Res. $237 $237

SOCCER CAMP LEVEL 2

FUTSAL CAMP (FULL-DAY)

Course #

Time

Day

Age Mtg.

Mon- 6-12 Fri.

4 5 5

Instructor: Kidz Love Soccer (Lincoln Glen Park) Course #

Res. $333 $417 $417

Time

Date

233.1.1037 9:00am-12:00pm 06/27-07/01 233.1.1040 9:00am-12:00pm 07/18-07/22

Day MonFri.

Age Mtg. 7-8

5 5

Res. $237 $237

SOCCER CAMP LEVEL 3

Instructor: Kidz Love Soccer (Lincoln Glen Park) Course #

Time

Date

233.1.1038 9:00am-12:00pm 06/27-07/01 233.1.1041 9:00am-12:00pm 07/18-07/22

Day

Age Mtg.

Mon- 9-10 Fri.

5 5

Res. $237 $237

50+ ACTIVE ADULT PROGRAMS: WILLOW GLEN VIRTUAL FITNESS

ZUMBA GOLD + TONING

Virtual Fitness is a fun way to exercise and communicate with friends! Willow Glen Virtual Fitness is for all who want to engage the five components of physical fitness. Willow Glen Virtual Fitness is designed to engage cardiovascular endurance, muscular strength, muscular endurance, flexibility, body composition, bone density, mental sharpness and increase body awareness. When participating in class have a chair, two weights, stretch band, and two or more bottles of water. Once you register you will receive Zoom ID and password via email.

Instructor: City of San Jose Staff Course #

Time

Date

255.4.1801 8:30am-9:30am

04/02-05/26

Day Tue. Thu. Sat.

FITNESS & HEALTH

Age Mtg.

Res.

50+

$120 (M) $128

Ditch the work out-Join the party!" Dance, socialize, and burn lots of calories with this fun modified Zumba option for active older adults. Zumba Gold recreates all the same Zumba moves you know and love with lower intensity and lower impact while still focusing on balance, range of motion, and coordination. The last portion of the class will consist of toning. Feel free to bring any of these items for the toning portion of the class: 2 lb. dumb bells (2), water bottles (2), canned foods (2). Spaces are limited in accordance to Covid-19 Guidelines. Masks are required for indoor programs. Registration is required for participation. No Drop ins available.

Instructor: City of San Jose Staff Room: Multi-Purpose Room Course #

Time

Date

Day

255.4.1806 10:30am-11:30am 04/01-05/13

Fri.

Age Mtg.

Res.

50+

$36 (M) $44

GET FIT WHILE YOU SIT Whether you walk or wheel, this fitness program is a good start. This program uses bands and dowels for strength and coordination. Participants are encouraged to go at their own pace. Spaces are limited in accordance to Covid-19 Guidelines. Masks are required for indoor programs. Registration is required for participation. No Drop ins available.

Instructor: PRNS Volunteer Room: Room 1 Course #

Time

Date

255.4.1901 11:00am-11:45am 03/28-06/13

Day

Age Mtg.

Mon.

50+

Res. $11 (M) $19

TAI CHI BEGINNER

Instructor: City of San Jose Staff Room: Multi-Purpose Room Time

Center yourself and create a positive intention for your day during this guided meditation, led by experienced teachers. Improve your physical and mental health while you reduce stress and anxiety. No prior experience required. Spaces are limited in accordance to Covid-19 Guidelines. Masks are required for indoor programs. Registration is required for participation. No Drop ins available.

Instructor: PRNS Volunteer Room: Room 6 Course #

Beginner Tai Chi. Tai Chi is an art embracing the mind, body, and spirit. Tai Chi is an effective exercise that consists of physical exercises and stretches. Tai Chi has been described as meditation in motion because it promotes serenity through gentle movements connecting the mind and body. The benefits of Tai Chi include reduced stress, improves mood, and better sleep, and promotes weight loss. Spaces are limited in accordance to Covid-19 Guidelines. Masks are required for indoor programs. Registration is required for participation. No Drop ins available.

Course #

MINDFULNESS MEDITATION

Date

255.4.1805 9:00am-10:00am 04/01-05/13

Day Fri.

Age Mtg. 50+

Res. $36 (M) $44

Time

Date

Day

Age Mtg. Res.

255.4.1902 10:00am-11:00am 03/30-06/08 Wed. 50+

$11 (M) $19

HEALTHY EXERCISE VIRTUAL An exercise class geared towards active adults that focuses on whole body exercise in a safe, fun, and challenging matter. This class is modified to each participant's level. We will use many evidenced based exercises that consist of cardio endurance for a healthy heart, muscular strength and endurance for strong bones and muscles, stretches / flexibility for healthy joints, and balance for fall prevention. We will emphasize core engagement and deep breathing for moving efficiently and reducing stress in activities of daily living to achieve optimal health. This a virtual class the zoom link for this class is provided on the class receipt.

Instructor: City of San Jose Staff Time Course # 255.4.1803 9:45am-10:45am

Date

3/29-5/26

Day Age Mtg. Res. Tue. 50+ 25 $125(M) Thu. $133 Sat.

(M) = Senior Membership Price

ARTS & SOCIAL

50+ ACTIVE ADULT PROGRAMS: ZOOM SOCIAL HOUR

NEWS AND VIEWS

Grab a cup of coffee, chat about current event, connect with old friends and meet new ones on Tuesdays via zoom.

The group meets to discuss local, state, national and world topics. The topics are often those found in the newspaper, in magazines, or on television. The intent is to share interpretations of these events. This is a social group, and topics are discussed for your enjoyment. Spaces are limited in accordance to Covid-19 Guidelines. Masks are required for indoor programs. Registration is required for participation. No Drop ins available.

Course #

Time

Date

255.4.1903 12:30pm-1:00pm 03/29-06/21

Day

Age Mtg.

Res.

Tue.

50+

Free

CREATIVE ARTS

Room: Room 5

Tap into your creative side and learn how to create art masterpieces. Experience the variety of creative crafts and the fun of a successful crafting session with others. This class is not lead by an instructor, students teach each other new techniques and crafts. Spaces are limited in accordance to Covid-19 Guidelines. Masks are required for indoor programs. Registration is required for participation. No Drop ins available. Participants must bring their own supplies to work with during this class.

Course #

Time

Date

Day

Age Mtg.

255.4.1911

TBD

04/01-06/10

TBD

50+

Res.

TBD $10 (M) $18

Instructor: PRNS Volunteer Room: Room 5 Course #

Time

Date

Day

255.4.1907 10:00am-11:30am 04/05-06/07 Tue.

Age Mtg.

Res.

50+

$10 (M) $18

(M) = Senior Membership Price

Scholarships Available The City of San Jose offers activity scholarships for children, seniors, and adults with disabilities who qualify. Scholarships will cover 50-70% of the class cost. Fill out the scholarship form and bring the necessary documents to any City of San Jose community center.

Contact any community center for information.

REGISTRATION FORM:

CITY OF SAN JOSÉ PARKS, RECREATION & NEIGHBORHOOD SERVICES Parent/Legal Guardian Information: First Name: Birthdate:

Last: /

Apt#:

Address: Zip:

City:

Home Phone: Email: Emergency Contact Name: Relationship:

New Address: Y N

Cell Phone:

Phone Number:

Gender Preference: Male Female

Non-Binary Gender Non-Conforming

Transgender Other:______________________

Race/Ethnicity (Choose all that apply): Black/African Descent Middle Eastern Hispanic/Latino Southeast Asian (e.g.,Thai, Cambodian) Caucasian/White South Asian (e.g., Indian, Pakistani) Vietnamese East Asian (e.g., Japanese, Chinese, Korean) Filipino Native American

American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander Decline to state Other:______________________

Preferred Spoken Language: English Spanish

Vietnamese Tagalog

Mandarin Cantonese

Decline to state Other:_____________________

Participant Information: (1) First Name:

Birthdate:

Last: Activity Name: Activity Name: Activity Name:

Course #: Course #: Course #:

Gender Preference: Male Female

Non-Binary Gender Non-Conforming

Transgender Other:______________________

Race/Ethnicity (Choose all that apply): Black/African Descent Hispanic/Latino Caucasian/White Vietnamese Filipino

Middle Eastern Southeast Asian (e.g.,Thai, Cambodian) South Asian (e.g., Indian, Pakistani) East Asian (e.g., Japanese, Chinese, Korean) Native American

American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander Decline to state Other:______________________

Preferred Spoken Language: English Spanish

Vietnamese Tagalog

CONTINUE ON THE BACK

Mandarin Cantonese

Decline to state Other:_____________________

Participant Information: (2) First Name:

Birthdate:

Last: Activity Name: Activity Name: Activity Name:

Course #: Course #: Course #:

Gender Preference: Non-Binary Male Gender Non-Conforming Female Race/Ethnicity (Choose all that apply): Black/African Descent Hispanic/Latino Caucasian/White Vietnamese Filipino

Middle Eastern Southeast Asian (e.g.,Thai, Cambodian) South Asian (e.g., Indian, Pakistani) East Asian (e.g., Japanese, Chinese, Korean) Native American

Transgender Other:______________________ American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander Decline to state Other:______________________

Preferred Spoken Language: English Spanish

Vietnamese Tagalog

Mandarin Cantonese

Decline to state Other:_____________________

Special Accommodations: The City of San José Department of Parks, Recreation and Neighborhood Services welcomes individuals with disabilities into programs. Please indicate any medical or behavioral concerns, and describe any accommodations needed for successful inclusion in the program(s). (Allergies, behavioral support food/medicine/environment, medical conditions, medications, etc.) Name: Special Accommodations: Payment Type: Check - payable to City of San Jose Cash

Credit Card Visa

MasterCard Discover

Credit Card Number:________________________________________Expiration Date:____/_____/_____ CVV_________Signature:_______________________________________________________________ Liability Waiver The Applicant has read the PRNS policies and procedures set forth within in consideration of the application to participate in classes/programs at a City facility or in a City sponsored class/program. Applicant agrees to defend, indemnify and hold harmless City, its officers, agents and employees (collectively referred to hereinafter as “City”) from and against any and all claims, demands, causes of action, or liabilities incurred by City arising, in whole or in part, directly or indirectly, from Applicant’s acts or omissions in connection with participation in the classes and programs described above, except as may arise from the gross negligence or willful misconduct of City. In any action or claim against City in which Applicant is defending City, the City shall have the right to approve legal counsel providing City’s defense and such approval shall not be unreasonably withheld. Applicant further agrees to release City from any and all claims for any damages, including property damage, injury or death occurring or arising out of use of City’s property, except as may be caused by the City’s gross negligence or willful misconduct. I understand and acknowledge that if participating in a program listed in CA Health and Safe code 124235, the enrolled participant is subject to concussion protocol as outline in CA Health & Safety124235 which includes “return to Play” procedures. I HAVE READ THE ABOVE AGREEMENT AND FULLY UNDERSTAND THAT I ASSUME ALL RISKS FOR INJURY RECEIVED.

Signature:_______________________________________________________________ Date:___________________

Photo Release I understand that City of San Jose may photography or video tale the events or activities in which I am (or my child is participating in. I give my permission for the City to use photographs or videotapes for me (or my child) for the purpose of promoting the City of San Jose and its services or for education purpose. I give my permission with the following understand: No compensation of any kind will be paid to me (or my child) at this time or in the future for the use of my (or my child’s) likeness. Permission is not required to participate in City events.

Signature:_______________________________________________________________ Date:___________________

FORMULARIO DE INSCRIPCIÓN:

DEPARTAMENTO DE SERVICIOS DE PARQUES, RECREACIÓN Y VECINDARIOSDE LA CIUDAD DE SAN JOSÉ Información del padre/madre/tutor legal: Nombre: Fecha de nacimiento: Apt#:

Apellido: Dirección: Postal:

Ciudad:

Teléfono particular: Dirección de correo electrónico: Nombre del contacto de: Relación:

Nueva dirección: S / N

Teléfono celular:

Teléfono:

Preferencia de Género: Masculino Mujer

No binario No conforme al género

Transgénero Otro:_______________________

Raza/origen étnico de los padres / tutores legales (elija todas las que correspondan): Ascendencia africana Medio este Nativo de Hawái/otra isla del Pacífico Hispano/latino Sudeste Asiático (p. ej., Tailandes, Camboyano) Indígena americano/nativo de Alaska Blanco no hispano Sur de Asia (p. ej., India, Pakistán) Me niego a declarar Vietnamita Este de Asia (p. ej., Japonés, Chino, Coreano) Otro:________________________ Filipino Nativo Americano Idioma hablado preferido de los padres/tutores legales: Inglés Español

Vietnamita Tagalo

Mandarín Cantonés

Me niego a declarar Otro:______________________

Información del participante: (1) Nombre:

Fecha de nacimiento:

Apellido: Nombre de la actividad: Nombre de la actividad: Nombre de la actividad:

Número de curso: Número de curso: Número de curso:

Preferencia de Género: Masculino Mujer

No binario No conforme al género

Transgénero Otro:_______________________

Raza/origen étnico del participante: Ascendencia africana Hispano/latino Blanco no hispano Vietnamita Filipino

Medio este Sudeste Asiático (p. ej., Tailandes, Camboyano) Sur de Asia (p. ej., India, Pakistán) Este de Asia (p. ej., Japonés, Chino, Coreano) Nativo Americano

Nativo de Hawái/otra isla del Pacífico Indígena americano/nativo de Alaska Me niego a declarar Otro:________________________

Idioma hablado preferido del participante: Inglés Español

SEGUIR

Vietnamita Tagalo

Mandarín Cantonés

Me niego a declarar Otro:______________________

Información del participante: (2) Nombre:

Fecha de nacimiento:

Apellido: Nombre de la actividad: Nombre de la actividad: Nombre de la actividad: Preferencia de Género:

Número de curso: Número de curso: Número de curso: No binario No conforme al género

Masculino Mujer

Transgénero Otro:_______________________

Raza/origen étnico del participante: Ascendencia africana Hispano/latino Blanco no hispano Vietnamita Filipino

Medio este Sudeste Asiático (p. ej., Tailandes, Camboyano) Sur de Asia (p. ej., India, Pakistán) Este de Asia (p. ej., Japonés, Chino, Coreano) Nativo Americano

Nativo de Hawái/otra isla del Pacífico Indígena americano/nativo de Alaska Me niego a declarar Otro:________________________

Idioma hablado preferido del participante: Inglés Español

Vietnamita Tagalo

Mandarín Cantonés

Me niego a declarar Otro:______________________

Adaptaciones especiales: El Departamento de Parques, Recreación y Servicios para Vecindarios de la ciudad de San José da la bienvenida a los programas a las personas con discapacidades. Indique cualquier condición médica o conductual que padezca el participante y describa las adaptaciones necesarias para la inclusión exitosa en los programas. (Alergias, apoyo conductual, alimentos/medicina/medioambiente, afecciones médicas, medicamentos, etc.) Nombre: Adaptaciones especiales: Tipo de pago: Cheque, pagadero a la ciudad de San José Efectivo

Tarjeta de crédito Visa

MasterCard Discover

Número de tarjeta de crédito:___________________________ Fecha de vencimiento:____/_____/_____ CVV:________________Firma:__________________________________________________________ Exención de responsabilidad El Solicitante ha leído las políticas y los procedimientos del PRNS establecidos en el presente en consideración de la solicitud para participar en clases/programas en una centro de la Ciudad o en una clase/programa patrocinado por la Ciudad. El Solicitante acepta defender, indemnizar y eximir de responsabilidad a la Ciudad, sus funcionarios, agentes y empleados (en adelante, denominados colectivamente como “Ciudad”) de y contra todas y cada una de las reclamaciones, demandas, causas de acción o responsabilidades incurridas por la Ciudad que surjan, en su totalidad o en parte, directa o indirectamente, de los actos u omisiones del Solicitante en relación con la participación en las clases y los programas descritos anteriormente, a menos que hayan podido surgir de la mala conducta de la Ciudad. En cualquier acción o reclamación contra la Ciudad en la que el Solicitante esté defendiendo a la Ciudad, la Ciudad tendrá el derecho de aprobar el asesoramiento legal que proporciona la defensa de la Ciudad y dicha aprobación no será denegada sin motivo razonable. Asimismo, el Solicitante acepta eximir a la Ciudad de toda reclamación por daños y perjuicios, incluidos daños a la propiedad, lesiones o muerte que ocurran o surjan del uso de la propiedad de la Ciudad, a menos que la negligencia grave o la conducta indebida intencional de la Ciudad hayan podido causar lo dicho. Comprendo y reconozco que, si participo en un programa incluido en el código 124235 de Salud y Seguridad de California, el participante inscrito está sujeto al protocolo de conmoción cerebral según se describe en el protocolo 124235 de Salud y Seguridad de California, que incluye los procedimientos para “regresar al juego”. HE LEÍDO EL ACUERDO ANTERIOR Y COMPRENDO PLENAMENTE QUE ASUMO TODOS LOS RIESGOS DE LESIONES QUE RECIBA.

Firma:_______________________________________________________________ Fecha:_____________________

Publicación de fotografía Comprendo que la ciudad de San José puede fotografiar o grabar en video los eventos o las actividades en los que participe yo (o mi hijo). Otorgo mi permiso para que la Ciudad use fotografías o videos míos (o de mi hijo) con el fin de promocionar la ciudad de San José y sus servicios/programas o con fines educativos. Otorgo mi permiso con el siguiente entendimiento: En este momento o en el futuro, no se me pagará ninguna compensación de ningún tipo a mí (o a mi hijo) por el uso de mi imagen (o la de mi hijo). No se requiere permiso para participar en los eventos de la Ciudad.

Firma:_______________________________________________________________ Fecha:_____________________

MẪU ĐĂNG KÝ:

THÀNH PHỐ SAN JOSÉ, SỞ DỊCH VỤ CÔNG VIÊN, GIẢI TRÍ VÀ VÙNG LÂN CẬN Thông tin về Phụ huynh/Người giám hộ Hợp pháp: Tên: Ngày sinh:

Họ: /

Căn hộ #:

Địa chỉ: Mã Zip:

Thành phố:

Điện thoại Nhà riêng: Địa chỉ Email: Người liên hệ khẩn cấp: Mối quan hệ:

Địa chỉ mới Y/N

Điện thoại Di động:

Điện thoại:

Giới tính đặc trưng: Nam Nữ

Phi nhị nguyên giới Không theo tiêu chuẩn giới tính

chuyển giới Khác:_______________________

Chủng tộc / Sắc tộc của Cha mẹ / Người giám hộ hợp pháp (Chọn tất cả các câu trả lời phù hợp): Người Da đen/Người gốc Phi Người gốc Tây Ban Nha/La-tinh Người Da trắng Không phải gốc Tây Ban Nha Người Việt Nam Người Philippines

Trung Đông Đông Nam Á (ví dụ: Thái Lan, Campuchia) Nam Á (ví dụ: Ấn Độ, Pakistan) Đông Á (ví dụ: Nhật Bản, Trung Quốc, Hàn Quốc) Người Mỹ bản xứ

Người bản xứ Hawaii/Cư dân Đảo Thái Bình Dương Khác Người Mỹ bản địa/Thổ dân Alaska Từ chối trả lời Khác:_______________________

Ngôn ngữ giao tiếp chính của Cha mẹ / Người giám hộ hợp pháp: Tiếng Anh Tiếng Tây Ban Nha

Tiếng Việt Tiếng Tagalog

Tiếng Quan Tiếng Quảng Đông

Từ chối trả lời Khác:______________________

Thông tin Người tham gia: (1) Tên:

Ngày sinh:

Họ: Tên hoạt động: Tên hoạt động: Tên hoạt động:

Số khóa học: Số khóa học: Số khóa học:

Giới tính đặc trưng: Nam Nữ

Phi nhị nguyên giới Không theo tiêu chuẩn giới tính

chuyển giới Khác:_______________________

Chủng Tộc/Dân Tộc của Người Tham Gia: Người Da đen/Người gốc Phi Người gốc Tây Ban Nha/La-tinh Người Da trắng Không phải gốc Tây Ban Nha Người Việt Nam Người Philippines

Trung Đông Đông Nam Á (ví dụ: Thái Lan, Campuchia) Nam Á (ví dụ: Ấn Độ, Pakistan) Đông Á (ví dụ: Nhật Bản, Trung Quốc, Hàn Quốc) Người Mỹ bản xứ

Người bản xứ Hawaii/Cư dân Đảo Thái Bình Dương Khác Người Mỹ bản địa/Thổ dân Alaska Từ chối trả lời Khác:_______________________

Ngôn ngữ Nói Ưa thích của Người tham gia: Tiếng Anh Tiếng Tây Ban Nha

TIẾP TỤC

Tiếng Việt Tiếng Tagalog

Tiếng Quan Tiếng Quảng Đông

Từ chối trả lời Khác:______________________

Thông tin Người tham gia: (2) Tên:

Ngày sinh:

Họ: Tên hoạt động: Tên hoạt động: Tên hoạt động:

Số khóa học: Số khóa học: Số khóa học:

Giới tính đặc trưng: Nam Nữ

Phi nhị nguyên giới Không theo tiêu chuẩn giới tính

chuyển giới Khác:_______________________

Trung Đông Đông Nam Á (ví dụ: Thái Lan, Campuchia) Nam Á (ví dụ: Ấn Độ, Pakistan) Đông Á (ví dụ: Nhật Bản, Trung Quốc, Hàn Quốc) Người Mỹ bản xứ

Người bản xứ Hawaii/Cư dân Đảo Thái Bình Dương Khác Người Mỹ bản địa/Thổ dân Alaska Từ chối trả lời Khác:_______________________

Ngôn ngữ Nói Ưa thích của Người tham gia: Tiếng Anh Tiếng Tây Ban Nha

Tiếng Việt Tiếng Tagalog

Tiếng Quan Tiếng Quảng Đông

Từ chối trả lời Khác:______________________

Tiện ích Hỗ trợ Đặc biệt: Thành phố San José, Sở Công viên, Giải trí và Dịch vụ Vùng lân cận hoan nghênh các cá nhân khuyết tật tham gia các chương trình. Vui lòng ghi rõ người tham gia với các vấn đề về y tế hoặc hành vi; và đưa ra bất kỳ yêu cầu tiện ích hỗ trợ cần thiết nào nhằm chuẩn bị tốt nhất để tham gia (các) chương trình: (Dị ứng, hỗ trợ hành vi, thực phẩm/thuốc/môi trường, bệnh trạng, thuốc, v.v.) Tên: Tiện ích Hỗ trợ Đặc biệt: Hình thức thanh toán: Chi phiếu — có thể thanh toán cho Thành phố San José Tiền mặt

Thẻ tín dụng Visa

MasterCard Discover

Số thẻ tín dụng:______________________________________________Ngày hết hạn:____/_____/_____ CVV:________Chữ ký:__________________________________________________________________ Miễn trừ Trách nhiệm Pháp lý Người đăng ký đã đọc các chính sách và quy chế PRNS khi đăng ký tham gia các lớp học/chương trình tại cơ sở của Thành phố hoặc trong các lớp học/chương trình do Thành phố tài trợ. Người đăng ký đồng ý bảo vệ, đảm bảo và miễn trừ cho Thành phố, các viên chức, đại diện và nhân viên của Thành phố (sau đây gọi chung là “Thành phố”) khỏi tất cả các khiếu nại, yêu cầu, kiện tụng hoặc trách nhiệm pháp lý, toàn bộ hoặc một phần, trực tiếp hoặc gián tiếp, phát sinh từ các hành vi hoặc thiếu sót của Người đăng ký liên quan đến việc tham gia các lớp học và chương trình như được mô tả ở trên, ngoại trừ trường hợp có thể phát sinh do sơ suất hoặc hành vi sai trái cố ý của Thành phố. Trong bất kỳ vụ kiên hoặc khiếu nại nào mà Người đăng ký đã cam kết bảo vệ cho Thành phố, Thành phố sẽ có quyền chỉ định cố vấn pháp lý bào chữa cho Thành phố và sự chấp thuận đó sẽ không bị từ chối một cách bất hợp lý. Người đăng ký đồng ý miễn trừ cho Thành phố khỏi tất cả các khiếu nại về thiệt hại, bao gồm thiệt hại về tài sản, thương tật hoặc tử vong xảy ra hoặc phát sinh từ việc sử dụng tài sản của Thành phố, ngoại trừ có thể do sơ suất hoặc hành vi sai trái cố ý của Thành phố. Tôi hiểu và xác nhận rằng nếu tham gia vào một chương trình được liệt kê trong bộ luật về Sức khỏe và An toàn CA 124235, người tham gia đã ghi danh phải tuân theo quy định phòng ngừa chấn động như được nêu trong bộ luật về Sức khỏe và An toàn CA 124235, trong đó bao gồm quy trình “Quay lại Tham gia”. TÔI ĐÃ ĐỌC THỎA THUẬN Ở TRÊN VÀ HIỂU RÕ RẰNG MÌNH PHẢI TỰ CHỊU MỌI RỦI RO THƯƠNG TÍCH, NẾU CÓ.

Chữ ký_______________________________________________________________ Ngày:_____________________

Công bố Ảnh Tôi hiểu Thành phố San José có thể chụp ảnh hoặc quay video các sự kiện hoặc hoạt động mà tôi (hoặc con tôi) tham gia. Tôi cho phép Thành phố sử dụng hình ảnh hoặc băng video về tôi (hoặc con tôi) cho mục đích quảng bá Thành phố San José và các dịch vụ/chương trình của thành phố hoặc cho mục đích giáo dục. Tôi cho phép trên cơ sở hiểu rằng: Tôi (hoặc con tôi) sẽ không được trả bất kỳ khoản bồi thường nào tại thời điểm này hoặc trong tương lai nếu hình ảnh giống tôi (hoặc con tôi) được sử dụng. Các sự kiện của Thành phố chào đón tất cả mà không cần phải xin phép trước.

Chữ ký_______________________________________________________________ Ngày:_____________________

報名表 : 聖荷西市公園、遊憩與鄰里服務部家長/法定監護人資訊: 名字: 姓氏: / / 出生日期: 地址: 郵遞區號: 新地址: 是/否公寓號碼: 城市: 住家電話: 行動電話: 電子郵件地址: 緊急聯絡人姓名: 關係: 電話: 性別取向：不受此二性別所限男性變性人性別不一致女性其他:_______________________ 父母/法定監護人的種族/族裔（選擇所有適用的）: 黑人/非洲人描述中東夏威夷原住民/其他太平洋島民西語裔/拉丁裔東南亞（例如泰國，柬埔寨）美洲印第安人/阿拉斯加原住民非西班牙裔白人南亞（例如印度，巴基斯坦）拒絕陳述越南語東亞（例如日本，中國，韓國）其他:_______________________ 菲律賓人美洲原住民參與者偏好的口語: 英文越南語國語拒絕陳述西班牙文其他加祿語廣東話他:_______________________ 參與者資訊: (1) 名字: 出生日期: / / 姓氏: 活動名稱: 課程編號: 活動名稱: 課程編號: 活動名稱: 課程編號: 性別取向：不受此二性別所限男性變性人性別不一致女性其他:_______________________ 參與者的種族/族裔:（請選擇所有適用選項）黑人/非洲人描述中東夏威夷原住民/其他太平洋島民西語裔/拉丁裔東南亞（例如泰國，柬埔寨）美洲印第安人/阿拉斯加原住民非西班牙裔白人南亞（例如印度，巴基斯坦）拒絕陳述越南語東亞（例如日本，中國，韓國）其他:_______________________ 菲律賓人美洲原住民參與者偏好的口語: 英文越南語國語拒絕陳述西班牙文其他加祿語廣東話他:_______________________

繼續

參與者資訊: (2) 名字: 出生日期: / / 姓氏: 活動名稱: 課程編號: 活動名稱: 課程編號: 活動名稱: 課程編號: 性別取向：不受此二性別所限男性變性人性別不一致女性其他:_______________________ 參與者的種族/族裔:（請選擇所有適用選項）黑人/非洲人描述中東夏威夷原住民/其他太平洋島民西語裔/拉丁裔東南亞（例如泰國，柬埔寨）美洲印第安人/阿拉斯加原住民非西班牙裔白人南亞（例如印度，巴基斯坦）拒絕陳述越南語東亞（例如日本，中國，韓國）其他:_______________________ 菲律賓人美洲原住民參與者偏好的口語: 英文越南語國語拒絕陳述西班牙文其他加祿語廣東話他:_______________________ 特殊遷就: 聖荷西市的公園、遊憩和鄰里服務部（Department of Parks, Recreation, and Neighborhood Services）歡迎身心障礙人士加入計劃。請註明參與者、任何醫療疾病，並說明成功參與計劃時任何所需的遷就：（過敏、行爲支持食物／藥物姓名: 特殊住宿: 支付: 支票 — 收款人為聖荷西市 City of San José 信用卡 MasterCard 現金 Visa Discover 信用卡卡號:___________________________________________________有效日期:____/_____/_____ CVV:____________簽名:_______________________________________________________________ 免責聲明

本申請人考慮申請參加本市設施或本市贊助的課程／計劃，並已閱讀列出的 PRNS 政策和程序。申請人同意為本市、其官員、代理人和員工（以下統稱為「本市」）辯護、賠償並使其免受任何及所有索賠、要求、訴訟原因，或本市因申請人在參加上述課程和計劃中的行為或不作為的行為而直接或間接引起的所有或部分責任；但因本市重大疏忽或故意不當行為而引起的情況，則不在此限。在申請人為本市辯護的任何針對本市的訴訟或索賠中，本市有權批准為本市提供辯護的法律顧問，且該批准不得有不合理拒絕之情事。申請人還同意免除對本市任何損害的索賠，包括因使用本市財產而發生或產生的財產損失、傷害或死亡；但因本市嚴重疏忽或故意不當行為而造成的情況，則不在此限。本人瞭解並承認，若參與 CA 健康及安全法規 124235 所列之計劃，納入之參與者將受到 CA 健康及安全 124235 所述之腦震盪計畫所約束，其中包括「重返播放」程序。我已經閱讀上述協議，並完全瞭解我承擔所受傷害的所有風險。 ◊ 簽名:_______________________________________________________________ 日期:______________________

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I understand that City of San Jose may photography or video tale the events or activities in which I am (or my child is participating in. I give my permission for the City to use photographs or videotapes for me (or my child) for the purpose of promoting the City of San Jose and its services or for education purpose. I give my permission with the following understand: No compensation of any kind will be paid to me (or my child) at this time or in the future for the use of my (or my child’s) likeness. Permission is not required to participate in City events.

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簽名:_______________________________________________________________ 日期:______________________

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