Skate Like a Girl Ongoing Program Partner Application

Skate Like a Girl Ongoing Program Partner Application

For afterschool programs and the like!
Thank you for your interest in partnering with Skate Like a Girl!

This form is for Schools (K-12), agencies (Boys and Girls Club, YMCA, etc), Parks and Rec Departments, and other entities who are interested in Skate Like a Girl providing ongoing programs at a particular site.

School Program Partners:
- For Fall Session (Sept-Dec)-Apply By May 1 (EXTENDED to May 31st)
- For Winter Session (Jan-Mar)-Apply By Sept 1
- For Spring Session (Apr-Jun)- Apply By Dec 1
If you are interested in Skate Like a Girl coming to your event or other one-day opportunity, This is not the correct form. For one-day events, please fill out our Event Partner Application.
Which Skate Like a Girl Chapter are You Looking to Partner With? *
ABOUT YOUR PROGRAM & SITE
Name of School or Agency *
What day(s) work for your site to host Skate Like a Girl? *

Monday Tuesday Wednesday Thursday Friday
Terms you are interested in hosting Skate like a Girl at your site: *

Fall (September-December) Winter (January-March) Spring (April-June) Summer (July-August)
Programs you'd like for your site: *

One 1 hour long class One 2 hour long class Two, back to back, 1 hour classes
Class Start Time *
Class End time *
Please list the specific dates of the program, and include any skipped days (holidays)
Example: January 8-March 1, skip January 21st.
Have We Offered This Program to Your Site in the Past? *

YES NO Yes, but it was different/long time ago Unsure
Will we be charged a fee for using your gym/program space? *

YES NO Unsure
Program Site Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Name *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
NEEDS FOR YOUR PROGRAM SITE:
Gear Needed for Your Site (What You Need Skate Like a Girl to Provide)

Helmets Pads Skateboards
Do you need us to do registration for this program? *

Yes, we do not have the ability to host registration No, we will do registration & give S.L.A.G. a roster of participants Unsure
Do you require additional insurance from Skate Like a Girl? *

Yes No Not Sure
Are you able to get a Skate Like a Girl waiver signed by each participant's parent/guardian prior to start date of services? *

Yes No
Any "Walk In" Participants? *

All participants will be "walk in" All participants will be pre-registered (on a roster) We will have both "walk in" and pre-registered participants
Amount of Participants: *

5-10 11-15 Unsure
Ages of Participants (Check All That Apply) *

Pre School K-5th grade 6-9th grade 10-12th grade 18 years or older
Describe Your Group and/or Any Special Needs You Have:
WHAT YOUR PROGRAM SITE CAN PROVIDE:
Secure Gear Storage *

Yes, we can provide a secure place to store gear No, we cannot provide storage unsure
Space to Provide Programming (Please Check All That Apply) *

Indoor Area w/ smooth ground (example: Gym) Outdoor Covered Area w/ smooth ground (example: Covered play court) Outdoor Area w/ smooth ground (basketball court) Reserved Classroom (for "rainy day" art projects, videos, etc) Nearby Skate Park (15 minute walk or less) Our agency can provide transportation (example: Van to skate parks) We would like to meet at All Together Skate Park (indoor) in Fremont (additional fees apply)
Has the Skate Program Space Been Secured and Approved? *

Yes, we are approved to use the spaces/resources listed above No, we have not gotten approval yet
Can Your Site Provide Snacks? *

Yes, we can No, we cannot Students provide their own snacks Unsure
Administrative Support (Check All That Apply)

Additional Staff and/or volunteer to support behavior management during class time Make roster & give to Skate Like a Girl prior to start of classes Collect Skate Like a Girl waivers prior to start of classes Support collection of demographic and other data for grant purposes
PRICING
Skate Like a Girl aims to eliminate any access barriers getting in the way of youth attending our classes. Therefore, we are moving to a group rate for the class rather than charging per student.

We base our 3-tier pricing off of what percentage of eligible participants (or of the student body for school-based programs) are low income, including rates for below average (under 30 percent), at average (30-40%), or above average rates (over 40%).

Once we have your form filled out, we will sent you a quote based on your site's needs. We aim for our lower income sites to pay under $5/student/hour, with our higher income sites paying $15/student/hour. These rates include instruction, all skate gear (helmets, pads, skateboards), and our unique SHRED curriculum.
The percentage of students at your site that are low income:
Amount of Participants & Rate Your Site Can Afford: *

5-10 Youth ($37.50/class) 5-10 Youth ($75/class) 5-10 Youth ($150/class) 11-15 Youth ($75/class) 11-15 Youth ($150/class) 11-15 Youth ($300/class)
If you selected "Other" please describe here:
Do you want youth to build their own skateboards (to keep) as part of this class? (may be additional charge)
Enter the message as it's shown *
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Skate Like a Girl Ongoing Program Partner Application

ABOUT YOUR PROGRAM & SITE

NEEDS FOR YOUR PROGRAM SITE:

WHAT YOUR PROGRAM SITE CAN PROVIDE:

PRICING