Registration Form—January/February 2013 Registration Dates: December 12(Residents) December 14 (Non-Residents) INSTRUCTIONS: To register, check the Register box next to each activity in which you would like to participate and the initials of the person registering. For trips please rank your trip choice from 1 (most desired) to 6 (least desired). You will receive a receipt in the mail confirming that you have been registered for the activities you selected. R = fee for Danville residents; NR = fee for non-residents.
NOTE: Information on refunds/cancellations/withdrawals and make-up classes are on page 4 Priority Participant (1-6) Initials
SENIOR SNEAKER TRIPS
Date
Time (approximate)
Fee
Rank Trip choices using “1” as first choice through 6 for last choice in the Priority Column
Register Participant (X) Initials
Register Participant (X) Initials
Whale Watching, Monterey Bay Barcode: 29517
Thursday January 10
7:45a.m.-5:00p.m.
R $76 NR $91
Steinbeck House, Salinas Barcode: 29518
Tuesday January 15
8:30 a.m.-5:30p.m.
R $70 NR $84
Wicked, Orpheum Theatre Barcode: 29533
Thursday January 24
11:00a.m.-5:30p.m.
R $115 NR $138
Norman Rockwell, Crocker Museum Barcode: 29516
Saturday February 2
10:30a.m.-5:00p.m.
R $50 NR $60
Sacred Places II Barcode: 29534
Wednesday Feb 20
11:00a.m.-6:30p.m.
R $72 NR $86
Davies Symphony Hall, San Francisco Barcode: 29519
Thursday February 28
7:45a.m.-1:00p.m.
R $45 NR $54
SPECIAL EVENTS
Date
Time (approximate)
Fee
Mardi Gras Celebration Barcode: 26991
Tuesday February 12
4:00p.m.-6:00p.m.
R $7 NR $9
Evening With Ruthe Steine Barcode: 26992
Wednesday February 20
6:30p.m.-8:30p.m.
Free
BUZZ SESSIONS & OLLI
Date
Time (approximate)
Fee
Your Cane, Your Friend Barcode: 29486
Tuesday January 8
9:00a.m.-10:00a.m.
Free
Give Yourself a Break Barcode: 29487
Tuesday January 15
10:00a.m.-11:00a.m.
Free
What is so Pinteresting? Barcode: 29488
Tuesday January 22
9:30a.m.-10:30a.m.
Free
Finding Your Family History Barcode: 29489
Tuesday, January 29
10:00a.m.-11:00a.m.
Free
Five Ways To Hold Title Barcode: 29490
Tuesday February 5
9:30a.m.-11:00a.m.
Free
Grocery Shopping With a Purpose Barcode: 29491
Tuesday February 12
10:00a.m.-11::00a..m.
Free
TOTAL FEES
Page 1
$
Participant Initials
Participant Initials
BUZZ SESSIONS & OLLI (Cont.)
Date
Time (approximate)
Fee
Diabetes Management Barcode: 29492
Tuesday, February 19
9:30a.m.-10:30a.m..
Free
Are Your Ducks in Order? Barcode: 29499
Tuesday February 26
10:00a.m.-11:00a.m.
Free
OLLI Lecture: Social Security for Baby Boomers Barcode: 29484
Tuesday, January 15
1:30p.m.-3:00p.m.
R $5 NR $6
OLLI Lecture: Mt. Diablo, Local Icon Barcode: 29485
Tuesday February 19
1:30p.m.-3:00p.m.
R $5 NR $6
CLASS/ACTIVITIES
Date
Time (approximate)
Fee
AARP Driving Safety Barcode: 29177
Thursday 1/17-1/24
9:00a.m.-1:00p.m.
See Registration info.
Basic Ballroom Dance Barcode: 29545
Wednesdays 1/2-2/27
11:45a.m.-12:35p.m.
Free
Bombay Jam—Demo Barcode: 29584
Tuesday January 8
5:30p.m.-6:30p.m.
Free
Bombay Jam Barcode: 29585
Tuesdays 1/15-2/26
5:30p.m.-6:30p.m.
R$49 NR $58
Bridge Basics II Barcode: 29607
Wednesdays 1/9-2/27
10:00a.m.-12:00p.m.
R $100 N $120
Cane Do Barcode: 28515
Tuesdays 1/8-2/26
9:00a.m.-10:00a.m.
R$65 NR $78
Chinese for Travelers Barcode: 29630
Saturdays 1/5-2/23
10:00a.m.-11:00a.m.
R $40 NR $48
Cooking Demo: Chinese New Year Barcode: 29672
Friday January 18
12:00p.m.-1:00p.m.
R $3 NR $4
Dancercise Barcode: 29544
Wednesdays, 1/2-2/27
10:50a.m.-11:40a.m.
Free
Gentle Stretch Barcode: 29560
Wednesdays 1/9-2/27
3:00p.m.-4:00p.m.
R $48 NR $57
Gluten Free Baking Barcode: 29673
Thursday January 24
1:00p.m.-4:00p.m.
R $40 NR $48
Jackie Sorensen’s Aerobic Dancing Barcode: 29477
Monday 1/7-2/25
5:30p.m.-6:30p.m.
R $30 NR $36
Jackie Sorensen’s Aerobic Dancing Barcode: 29478
Wednesday 1/9-2/27
5:30p.m.-6:30p.m.
R $42 NR $50
Line Dance - Beginner/High Beginner Barcode: 29674
Thursdays 1/3-2/28
10:00a.m.-11:00a.m.
R $24 NR $29
Line Dance - High Beginner/ Easy Intermediate Barcode: 29675
Thursdays 1/3-2/28
11:15a.m.-12:15p.m.
R $24 NR $29
Lotions & Balms Barcode:29683
Thursday February 7
1:00p.m.-3:00p.m.
R $35 NR $42
TOTAL FEES
Page 2
$
Participant Initials
CLASSES/ACTIVITIES (cont.)
Date
Time (approximate)
Fee
Luk Tung Kuen Barcode: 29543
Wednesdays 1/2-2/27
10:00a.m.-10:40a.m.
Free
Scrabble, Fun With Words Bar Code: 29588
Tuesdays 1/8-2/26
12:30p.m.-3:00p.m.
Free
Senior Stretching Barcode: 29566
Fridays 1/4-2/22
9:15a.m.-10:15a.m.
R $25 NR $30
Sit to Get Fit Barcode: 29557
Mondays 1/7-2/25
9:00a.m.-10:00a.m.
R $60 NR $72
Spanish Conversation Barcode: 29579
Mondays 1/7/-2/25
11:00a.m.-12:30p.m
R $40 NR $48
Tai Chi Barcode: 29542
Wednesdays 1/2-2/27
9:00a.m. – 9:50a.m.
Free
Tai Chi Chih and Qi Gong Barcode: 29680
Tuesdays 1/8-2/26
10:30a.m.-11:30a.m.
Free
The Film Salon Barcode: 29475
Wednesdays 1/9-2/27
1:30p.m.-4:30p.m.
R $40 NR $48
Ukulele Barcode: 29586
Tuesdays 1/8-2/26
2:30p.m.-3:30p.m.
R $80 NR $96
Writers Group Barcode: 29682
Tuesdays 1/8-2/26
5:30p.m.-6:30p.m.
R $40 NR $48
Yoga Barcode: 29562
Mondays 1/7-2/25
11:00a..m.-12:15p.m.
R $57 NR $68
Yoga Barcode: 29563
Mondays 1/7-2/25
12:30p.m.-1:45p.m.
R $57 NR $68
Yoga Barcode: 29561
Wednesdays 1/9-2/27
8:15.m.-9:30.m.
R $76 NR $91
Zumba - Mondays Barcode: 29480
Mondays 1/7-2/25
4:10p.m.-5:10p.m.
R $42 NR $50
Zumba Gold - Thursdays Barcode: 29481
Thursdays 1/10-2/28
5:30p.m.-6:30p.m.
R $56 NR $67
Welcome to Medicare Barcodes: 29637
Saturday January 12
Welcome to Medicare Barcodes: 29638
Saturday, February 9
10:00a.m.–12:30p.m.
TOTAL FEES
Page 1
$
TOTAL FEES
Page 2
$
TOTAL FEES
Page 3
$
TOTAL FEES
$
10:00a. .m.– 12:30p.m.
Free Free
FEES
Senior Services Sub-committee Meeting Wednesday, January 23, 2013 at 4:00 p.m. REGISTRATION INFORMATION Mail or drop off your registration form to the Danville Senior Center or the Danville Community Center. All resident registrations received by December 11 at 5:00p.m. will be processed beginning Wednesday, December 12, with no priority given. Non-resident registration will begin on Friday, December 14. Phone and walk-in registration will begin on Monday, December 19. To register by phone, please contact the Danville Senior Center (925) 314-3490. Senior Sneaker trips will meet at the Danville Park and Ride lot. Please note times listed for each Senior Sneaker trip are approximate. Staff will mail out a detailed checklist approximately one week before the trip with exact meeting time. Class Cancellation/Withdrawals Requests for withdrawal will be honored if requested no later than 5 business days prior to the first day of class. Requests made less than 5 business days prior to the first day of class must be submitted in writing and will be considered on an individual basis. A $20 processing fee will be charged for processing refunds. Make-up Classes Whenever possible, make-up classes will be given on those occasions when inclement weather or instructor illness requires that a class be cancelled. No refunds (whole or partial) can be given for classes missed by the student. Senior Sneaker Trip Refund Policy: When registration falls below the minimum enrollment required, it may be necessary to cancel a trip. At the time of cancellation, the Town will initiate a full refund. Please allow 3 to 4 weeks for refunds to be processed. Withdrawal and refund requests must be submitted five working days prior to the trip. You may elect to receive a full credit on your account or a refund with a $20 cancellation fee. Refunds will not be given for trips designated (no refund). Senior Sneaker Trip Registration Priority: Due to the high demand of the Senior Sneaker program, seniors will be limited to registering for two trips per month, or a total of four per issue of the Silver Streak newsletter. When choosing your trips, please number them in order of priority. In Case of Emergency: Please call Senior Services to verify that your emergency contact information is current. Since prompt medical care is crucial in an emergency, the Town would like to ensure we have the most current information for each participant. If you wish to register by mail, complete the form and mail with payment to: Danville Senior Center Attn: Class Registrations 115 E. Prospect Avenue Danville, CA 94526 (Circle One): Name (s):
Check
Checks payable to “Town of Danville� Cash (exact amount) MasterCard Visa
AMEX
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