Brown Voyages – Spring 2013
Second Session Clubs Registration Form
Registration has been extended for our “second session” clubs this semester – those that are starting April 1 and later!
Please use this form to sign up your child for any of the following clubs. One form per child, please. All “second session”
registration forms are due to the front office or brownclubs@googlegroups.com no later than Friday, March 22.
CLUB JUMPBUNCH ($62 per 4 week session) – for 1st through 5th graders
Club JumpBunch gets school-age children moving with over 75 different sports and fitness games taught in a fun and
non-competitive learning environment! This nationwide program partners with Michelle Obama’s Let’s Move campaign
to combat childhood obesity and uses trained coaches with proven lesson plans to improve cognitive development
abilities as well as balance, endurance, motor skills, teamwork and self-confidence! Club JumpBunch also introduces 60second challenges each week that require students to work as a team to accomplish physical and mental challenges that
support coordination, body control, and hand-eye coordination!
Option 1: Monday afternoons, week of 4/1 – week of 4/22. Club ends each day at 5:00pm. $62.
Option 2: Monday afternoons, week of 4/29 – week of 5/20. Club ends each day at 5:00pm. $62.
MAD SCIENCE: SEEKING OUR SENSES ($59) – for ECE and Kindergarten
This workshop is an introduction to how our five senses work and function and the ways in which we use them in our
everyday lives. Through hands-on experiments and activities students will have the opportunity to explore the
importance of all five senses. Students will be escorted from their classroom to the club location.
Schedule: Tuesday afternoons, week of 4/15 – week of 5/13. Club ends each day at 4:45pm. $59.
S.T.E.M. CONCEPT USING LEGO® BRICKS ($68) – 2 sessions available; one for Kindergarten through 2nd graders, and
one for 3rd through 5th graders
This is a hands-on class where students build educational motorized models, which include inventions, transportation,
and other gadgets. Kids already know how to build with LEGO® bricks, but with a little coaching, they can learn about
engineering, architecture, physics and math using specialized components. Every class is a new project.
Schedule: K-2nd grade, Wednesday afternoons, week of 4/15 – week of 5/20. Club ends each day at 5:00pm. $68.
3rd-5th grade, Wednesday afternoons, week of 4/15 – week of 5/20. Club ends each day at 5:00pm. $68.
MAD SCIENCE: SEEK, FIND, SOLVE ($72) – for Kindergarten through 5th graders
Learn the art of writing secret messages and how they produce those magical moments in the movies. We'll explore
PHun PHactors aPHecting acids and bases. Prepare your mind for a fun ride on Mad Science machines as we seek, find
and solve the mysteries of science.
Schedule: Thursday afternoons, week of 4/15 – week of 5/13. Club ends each day at 5:00pm. $72.
Registration:
Complete the registration information on the reverse side, include your payment, and submit it to the front office or by
email to brownclubs@googlegroups.com by Friday, March 22. Be sure to include your club fees (if you are paying via
check made out to Brown PTA or cash, please give that payment attached to this completed form to the front office). If
you would like to pay by credit or debit card, please complete the requested information on the reverse side or call
Michelle Malgesini at 303-242-9747 to give your credit card number over the phone.
See Reverse Side for Registration Form
Registration forms are due to the front office or brownclubs@googlegroups.com by Friday, March 22, 2013
If you need assistance, contact brownclubs@googlegroups.com or Michelle at 303-242-9747 or Julia at 303-902-5504.
Please register my child for these sessions:
X
Club Sessions Available
Grade Level
Session Dates
Cost
Club JumpBunch Option 1
1st - 5th grade
Mon, week of 4/15 - 4/22
$62
Club JumpBunch Option 2
1st - 5th grade
Mon, week of 4/29 - 5/20
$62
Mad Science: Seeking Our Senses
ECE - Kinder
Tues, week of 4/15 - 5/13
$59
S.T.E.M. Concept Using Lego® Bricks
Kinder - 2nd grade
Wed, week of 4/15 - 5/20
$68
rd
th
S.T.E.M. Concept Using Lego® Bricks
3 - 5 grade
Wed, week of 4/15 - 5/20
$68
Mad Science: Seek, Find, Solve
Kinder - 5th grade
Thurs, week of 4/15 - 5/13
$72
Program Enrollment Fee (payable once per school year)*
Total Payment Enclosed:
Cash
Amount
Enclosed
$25
Check
Credit Card
$
Credit Card Number: ______________________________ Exp Date: __________ Security Code:___________
*Program Enrollment Fee: An annual program enrollment fee ($25, payable once per school year) is due for each child
participating in clubs at Brown. If you have not submitted this fee yet this school year, you must include that fee with
your club registration form and payment.
Student Info:
Student name______________________________________
Parent name___________________________________
Homeroom teacher_________________________________
Grade_________________________________________
Parent email_______________________________________
Parent Phone #_________________________________
Physician Name____________________________________
Physician Phone #_______________________________
Emergency Contact Name____________________________
Relationship___________________________________
Emergency Contact Phone (Primary and Alternate)_________________________________________________________
May your child walk home after being released from afternoon club?
No
Yes
Is your child in Kaleidoscope before school? . . . . . . . . .
No
Yes:
Mon
Tue
Wed
Thu
Fri
Is your child in Kaleidoscope after school? . . . . . . . . .
No
Yes:
Mon
Tue
Wed
Thu
Fri
Does your child have any health/medical concerns that we should be aware of?
No
Yes, please describe:
__________________________________________________________________________________________________
Does your child have a food allergy or special nutritional requirement?
No
Yes
If you marked yes, you are acknowledging that Brown PTA cannot provide a snack to your child and he/she will be seated
separately from the larger group in order to ensure his/her safety.