Southside Community Center | Winter 2023 | Community Activity Guide

SOUTHSIDE

COMMUNITY CENTER 5585 COTTLE RD 408-629-3336

WINTER CAG 2023

PROGRAMS FOR ALL AGES SCHOLARSHIP DETAILS INSIDE!

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

YOUR COMMUNITY. YOUR BROCHURE. HEALTHY COMMUNITIES THAT INSPIRE BELONGING EVERYWHERE

CENTERS OUTDOORS NEIGHBORHOODS IN THE FUTURE

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.

SCHOLARSHIPS www.activatesj.com

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.

SOUTHSIDE

COMMUNITY CENTER 5585 COTTLE RD 408-629-3336

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

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

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

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

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

(408) 793-5565

SJREGISTRATION@SANJOSECA.GOV

WHAT'S INSIDE WINTER 2023

1

CITYWIDE COMMUNITY CENTER INFO

2

WHAT'S INSIDE WINTER 2023

3

CENTER AND STAFF INFO

4

GENERAL REGISTRATION INFO

5

INCLUSION PROGRAMS

6

PRESIDENT'S BREAK CAMP SJ INFO

7

2022-23 ROCK AFTERSCHOOL INFO

8

2022-23 SAN JOSE REC PRESCHOOL

9

YOUTH LEISURE CLASSES

10

SENIOR MEMBERSHIP INFORMATION

11

ACTIVE ADULT 50+ FITNESS CLASSES

12

ACTIVE ADULT 50+ LEISURE CLASSES

13

RENTAL INFORMATION

14

2023 REGISTRATION FORM

CONTACT US ADDRESS

STAFF

5585 Cottle Rd. San Jose, Ca 95123

Janae Whitcomb

PHONE NUMBER 408-629-3336 408-629-3435

FAX NUMBER 408-365-7135

WEBSITE PAGE sanjoseca.gov/prns

HOURS OF OPERATION Monday 8:30 a.m. - 6 p.m.

Tuesday 8:30 a.m. - 6 p.m.

Wednesday 8:30 a.m. - 6 p.m.

Thursday 8:30 a.m. - 5 p.m.

Friday 8:30 a.m. - 4 p.m.

Saturday 10 a.m. - 2 p.m.

Southside Center Supervisor

janae.whitcomb@sanjoseca.gov

Angela Williams

50+ Active Adults Programs angela.williams@sanjoseca.gov

Dustin Gordon

San Jose Rec Preschool/ Leisure Programs dustin.gordon@sanjoseca.gov

Angelica Alejo-Martinez

R.O.C.K Afterschool/ Camp SJ angelica.alejo-martinez@sanjoseca.gov

Marta Mirles

Rental Facility Coordinator marta.mireles@sanjoseca.gov

CITY HOLIDAY CLOSURES Thanksgiving Christmas New Years

November 24 - 25, 2022 December 23 - 29, 2022 December 30 - 31, 2022, January 1, 2023

FIND US ON yelp.com/biz/southsidecommunity-center-san-jose facebook.com/SouthsideCCSJ

REGISTRATION SUMMER CAMPS & SPRING CLASSES

SATURDAY FEBRUARY 25 10:00 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.

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.

PRESIDENTS BREAK CAMP 2023

SOUTHSIDE COMMUNITY CENTER

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. TUESDAY - FRIDAY 2/21 - 2/24

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, skill building, new friendships, learning projects and much more! *Safety is our main priority and we will continue to follow all Santa Clara County and state of California guidelines. Please contact (408) 629-3336 if you have questions about our operating procedures.

Please keep your child home if they are displaying any signs of illness and report the absence to Angelica Alejo-Martinez at (408) 629-3336 or Angelica.alejo-martinez@sanjoseca.gov

CAMP SAN JOSE SESSION: $215 PRIORITY REGISTRATION *OPENS 11/09 AT 10 A.M. GENERAL REGISTRATION OPENS 11/19 AT 10 A.M.

*For additional information please contact Angelica Alejo-Martinez.

*Priority registration is for scholarship-eligible families. Scholarships are available for those who qualify; awarded as funding is available.

Please contact your local Community Center for more info.

Sign up at sjregistration.com For any questions, email sjregistration@sanjoseca.gov

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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 Anderson Elementary Baldwin Elementary Frost Elementary Taylor Elementary

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)

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REGISTRATION Registration opens Saturday, July 23, @ 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 Southside Community Center 5585 Cottle Rd, San Jose, CA 95123 (408) 629-3336 email: angelica.alejo-martinez@sanjoseca.gov

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

SAN JOSE RECREATION PRESCHOOL DISCOVER

LEARN

PLAY

Little Learners- Room 10

Children will be introduced to socialization, positive self-esteem, following directions, and simple learning concepts. Children will work on hand-eye coordination and motor skills while gaining independence through the use of circle time, music, songs, stories, play, arts and crafts. Food will be provided for cooking activities and may be provided for special events.

Requirements for parent participation varies by center.

Children must be able to use the restroom unassisted.

All children must have valid immunization records on file by the first week of program.

No child under the age of 4 years 9 months can be enrolled for over 12 hours of San Jose recreations programs per week.

Course Number

Time

Date

Day

216.5.0305

9:30- 12:30 p.m.

8/29/22- 6/1/23

M-Th

Instructors

Age 3-4.5

Ms. Tiffany/ Ms. Brenda

Kinder Prep- Room 4

This class prepares your child for kindergarten with age-appropriate activities, learning concepts, socialization skills and fun. Your child will gain understanding of shapes, colors, prephonics, literacy building (i.e. identifying letter sounds, writing the alphabet and simple words), number recognition, and counting to to 30. The goal is to have fun, participate, and learn.

Requirements for parent participation varies by center.

Children must be able to use the restroom unassisted.

All children must have valid immunization records on file by the first week of program.

No child under the age of 4 years 9 months can be enrolled for over 12 hours of San Jose recreation programs per week.

Course Number 216.5.0306

Time

Date

9:30- 12:30 p.m.

8/29/22- 6/1/23

Day M-Th

Age 4-5

Instructors Mrs. Shelley/Mrs. Monique

2023-24 SJRP REGISTRATION INFO Priority Registration for returning families will be available on Saturday, February 11th at 10:00 a.m.

General Registration for new families opens on Saturday, February 18th at 10:00 a.m.

Register at www.sjregistration.com

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WINTER CLASSES

ART, DANCE AND SPORTS MINI GYM STARS

TAP/BALLET DANCE CLASS A fun beginning dance class where students learn Ballet warmups and Tap steps! Parents are allowed to stay the first 10 minutes on the first day of class and are encouraged to attend the last class for a great recital.

Instructor: Dance Arts Academy Location: Southside C.C.- Fitness Room

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.

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 great recital.

Instructor: Dance Arts Academy Location: Southside C.C.- Fitness Room

Course #

Time

Date

Day

Age Mtg.

Cost

216.3.0211

10:00- 10:55 a.m.

1/14-3/4

Sa

4-8

$128

Course #

Suggested Attire: a leotard, stretch pants/leggings, sweat pants, or shorts.

Bare feet during class is suggested.

We recommend children secure long hair back in a high ponytail.

216.3.0800

8

Time

Date

11:00-11:55 a.m.

1/14-3/4

Day Sa

Age Mtg. 4-8

8

Cost $128

GYM STARS

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

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 great recital.

Instructor: Dance Arts Academy Location: Southside C.C.- Fitness Room Course #

Time

Date

216.3.0802 12:00-12:55 p.m. 1/14-3/4

Day Age

Mtg.

Sa 7-12

8

Cost

$128

FUNDAMENTALS OF CARTOON DRAWING Learning basketball has never been more fun! These classes focus on dribbling, shot technique, passing and team work. Adjustable hoops and appropriately sized basketballs are used to always provide just the right amount of challenge.

This winter in Young Rembrandts, we’ll go topsy-turvy for our cartoon lessons. The never-ending rivalry rages on as the cats and dogs go at it again in the month of January. Develop a different and more expressive appreciation for vegetables as we draw veggie expressions in January as well. In February, weirder means better as we draw unusual pets and put the pedal to the metal as we race to create cartoon car expressions in March. Enroll today!

Instructor: Skyhawks Sports Academy Location: Southside C.C.- Fitness Room

Instructor: Young Rembrandts Location: Southside CC- Room 6

HOOPSTER TOTS

Course #

Time

Date

Day Age

Mtg

Cost

216.3.0820

1:00-1:45 p.m.

1/17-2/7

Tu

3-5

4

$105

216.3.0821

1:00-1:45 p.m.

2/21-3/14

Tu

3-5

4

$105

Course #

Time

216.3.0131

4:30-5:30 p.m.

Date 2/22-3/22

Day W

Age Mtg Cost $96 6-11 5

FUNDAMENTALS OF DRAWING

Experience the colorful magic of fall in the Young Rembrandts classroom.

Kick off the season with an interesting Iguana, a video game favorite Pixel Block Character and the geometrical world of architecture as we draw the Notre Dame Cathedral. Later, students will immerse themselves in the seasonal spirit as they learn still life technique of pumpkins, draw a detailed Scarecrow, and draw a silly but challenging Patterned Bat. Finally, get ready for winter as we turn out a “sweet” drawing of a gingerbread house (almost good enough to eat!). Sign up now!

Instructor: Young Rembrandts Location: Southside CC- Room 6 Course # 216.3.0130

9

Time 4:30-5:30 p.m.

Date

Day

Age

Mtg.

Cost

1/11-2/8

W

6-11

5

$96

Register at www.sjregistration.com

Adult 50+ Memberships Register online at sjregistration.com or return the attached membership form to Southside Community Center to get your 2023 membership now available at no cost.

www.sjregistration.com

Member Benefits: Free programs Senior resources Newsletters Member-only events And more!

SOUTHSIDE COMMUNITY CENTER 5585 Cottle Rd. San Jose, CA 95123 408.629.3336

ACTIVE ADULTS 50+

FITNESS & HEALTH

TAI JI QUAN

YUAN JI DANCE

Would you like to improve your strength and balance while relieving stress? If so, join our class to learn the slow, meditative movements and deep breathing techniques of Tai Chi. Tai Ji Quan is great in helping the body improve strength and balance, and helps relieve stress. This class also has a dance element incorporated.

Traditional Chinese dance brings energy, enjoyment and well-being to the body while the mind enjoys the harmony of the music bringing peace and balance.

Come get your body moving while you learn this unique and beautiful style of dance.

Instructor: Volunteer Led Loc: Southside C.C.- Rooms 8 & 9 Course #

Time

Date

Day

Mtg

Cost

F

11

M-$11 NM-$19

219.3.1911 9:00- 11:00 a.m. 1/13-3/24

Instructor: Volunteer Led Loc: Southside C.C - MPR Course #

Time

219.3.1902 1:30-3:30 p.m.

Date

Day

Mtg.

1/11-3/22

W

11

Cost

M-$11 NM-$19

FITNESS OVER 50

Tai Chi is an internal form of Chinese Martial Arts known for its slow, graceful movements and breathing techniques. It has become a popular form of exercise all over the world. Like most exercises, practicing Tai Chi can help one improve their strength, flexibility, circulation, and relaxation.

Instructor: Volunteer Led Loc: Southside C.C.- Room 9 No Class on 1/16, 2/20

Course #

Time

Date

219.3.1901 9:00-10:00 a.m. 1/9-3/20

Day M

Mtg.

9

Cost

M-$9 NM-$17

TABLE TENNIS/ PING PONG

The most popular racket sport in the world! Table Tennis is a fun activity that will make you work up a sweat while improving your hand eye coordination. Play for fun or enjoy some friendly competition.

This is a Self Led class, no Instructor present, all levels are welcome.

Instructor: Volunteer Led Loc: Southside C.C.- Room 6/9 No Class on 1/16, 2/20

Course #

Time

Date

Day

Mtg.

219.3.1909 1:00-3:00 p.m.

1/9-3/13

M

8

Cost M-$8 NM-$16

219.3.1909 1:00-3:00 p.m.

1/11-3/15

w

10

M-$10 NM-$18

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.

11

Register at www.sjregistration.com

ACTIVE ADULTS 50+

RECREATION & LIESURE

QUILTERS Quilting is done on bed spreads, quilt-art wall hangings, clothing, and a variety of textile products.

This group loves to design beautiful unique quilts.

The class is for beginners & experienced quilters.

Lots of helpful advice available.

Instructor: Volunteer Led Loc: Southside C.C.- Room 9 Course #

Time

HANDWORK FOR OTHERS Enjoy socializing with others while creating wonderful blankets and clothing items for donation.

Registration will be required to participate.

Instructor: Volunteer Led Loc: Southside C.C.- Room 7 Course #

Date

219.3.1908 9:00-12:00 p.m. 1/10-3/21

Day Tu

Mtg. Cost

11

M- $22 NM- $30

Time

219.3.1899 9:30-11:30 a.m.

Date 1/13-3/24

Mtg. Cost 11 FREE

Day Th

HORSE SHOE CLUB Enjoy socializing with others while socializing and staying active. Join the Horseshoe club to stay active. It is a FREE course BUT registration is required to participate.

Registration will be required to participate.

Instructor: Volunteer Led Loc: Southside C.C.- Near Rose Garden No Class on 1/16, 2/20 Course #

Time

Date

Day Mtg. Cost

219.3.19129:00-12:00 a.m. 1/19-3/24 M/F

20

FREE

KNITTING AND CROCHET CLUB Seeking beginners and advanced knitters and crochet enthusiasts to help grow our group! We are a small group of beginning and advanced knitters and crocheters who enjoy making things. We will accomplish lots of work while socializing and sharing techniques are spread around. Join us for a day and you will see the magic we create.

Instructor: Volunteer Led Loc: Southside C.C.- Room 7 Course #

Time

Date

219.3.1903 9:30-11:30 a.m. 1/13-3/24

Day Mtg. F 11

Cost M-$11 NM-$19

TAP DANCE WITH THE DAZZLING DIVAS Welcome to Tap! Dancers will practice basic rhythmic tap skills, and terminology. Some may participate in warm ups, dance routines, and possible traveling performances.

Beginner fundamentals such as balance and general alignment are introduced, intermediate and advanced also welcome. Registration will be required to participate.

Instructor: Volunteer Led Loc: Southside C.C.- Fitness Room Course # 219.3.1913

Time 10:00-12:00 p.m.

Register at www.sjregistration.com

Date 1/19-3/24

Day Mtg. Cost T

11

FREE

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RENTALS

SOUTHSIDE COMMUNITY CENTER

USE OUR SPACE FOR YOUR NEXT SPECIAL EVENT SOUTHSIDE COMMUNITY CENTER IS THE PERFECT PARTY VENUE FOR ANY OCCASION! Birthday Parties Company Events Baby Showers Receptions Club Meetings Or any special occasion

SOUTHSIDE COMMUNITY CENTER

For more information contact Marta Mireles Marta.mireles@sanjoseca.gov

(408) 629-3336 5585 Cottle Road, San José CA, 95123

Fees and Room Information

Basic Guidelines Application Fee Basic Rate: $60.00 *Discounted Rate: $40.00 *Discounted Rate: City of San Jose Departments, Government Agencies, Schools, Non-Profits (Non-Profits are defined as tax-exempt organizations serving San Jose residents and at the time of application, show proof of Federal and State tax exempt status with a Letter of Determination) and San Jose Service Organizations which serve Seniors, Youth or the Disabled (proof of organized structure: by-laws or articles of incorporation).

Non-Peak Hours: M-Th & Friday until 4 p.m.

Peak Hours: Friday at 4 p.m. - Sunday, 11p.m.

Room Capacity Classrooms: Multi-Purpose Room:

Note: Groups that intend to serve alcohol will pay an additional deposit of $500.00 per application

NONE PEAK HOURS

HOURLY RATE

Classroom Basic Rate Classroom Discounted Rate Multi-Purpose Room Basic Rate Multi-Purpose Discounted Rate

$50.00 / hr $15.00 / hr $135.00 / hr $35.00 / hr

PEAK HOURS

HOURLY RATE

Classroom Basic (Peak) Classroom Discounted (Peak) Multi-Purpose Room Basic (Peak) Multi-Purpose Discounted (Peak)

$65.00 / hr $30.00 / hr $160.00 / hr $75.00 / hr

STAFFING

HOURLY RATE

Rental Staff *All rentals require a minimum of one staff member Security Guard (s) *Two security guards are required if alcohol is being served

$25.00 / hr

DEPOSITS

NO ALCOHOL

Classroom Multi-Purpose Room

$50.00 $500.00

$30.00 / hr per security guard

Additional Information

2 hour minimum for all rentals in classrooms & multi-purpose room.

50% of fees are required to reserve a date. Balance is due 30 days prior to event.

Full payment is required if reservation is made 30 days or less prior to the date of the event and pending Recreation Supervisor approval.

(Cash or Credit Card Only) There is a $5 Late Application Fee for reservations made less than 30 days prior to the event.

There is a $20 fee for any changes to a reservation.

Discounted rates apply with valid proof of non-profit tax exempt status.

There will be charge of $5.00 to remove any balloons left behind.

Additional Equipment $100 FLAT RATE FEES VARY BY CENTER

REGISTRATION FORM:

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

First Name: Address: Home Phone: Emergency Contact Name:

Last: Apt#: City: Cell Phone: Relationship:

Birthdate: Zip:

/

/

New Address: Y N

Email: Phone Number:

Gender Preference: (Choose all that apply) Woman Man

Transgender Gender Non-Conforming

Non-binary Prefer to self-describe

Parent/Legal Guardian 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 respond

Parent/Legal Guardian Preferred Spoken Language: Other:__________________ Decline to state

English Vietnamese Spanish Tagalog Decline to state Other:________________

Mandarin Cantonese

Participant Information: (1) Last:

First Name:

Birthdate:

Course #:

Course #:

Course #:

Course #:

Course #:

Course #:

/

/

Gender Preference: Woman Man

Transgender Gender Non-Conforming

Non-binary Prefer to self-describe

Participant’s Race/Ethnicity (Choose all that apply): Black/African Descent Hispanic/Latino Caucasian/White Vietnamese Filipino Middle Eastern

Decline to respond

Participant’s Preferred Spoken Language:

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

Other:__________________ Decline to state

English Vietnamese Spanish Tagalog Decline to state Other:________________

Mandarin Cantonese

Participant Information: (2) Last:

First Name:

Birthdate:

Course #:

Course #:

Course #:

Course #:

Course #:

Course #:

/

/

Gender Preference: Woman Man

Transgender Gender Non-Conforming

Non-binary Prefer to self-describe

Participant’s Race/Ethnicity (Choose all that apply): Black/African Descent Hispanic/Latino Caucasian/White Vietnamese Filipino Middle Eastern

Decline to respond

Participant’s Preferred Spoken Language:

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

Other:__________________ Decline to state

English Vietnamese Spanish Tagalog Decline to state Other:________________

Mandarin Cantonese

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: Payment Type: Check - payable to City of San Jose Cash

Special Accommodations: 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 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___________________

NOTES

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