Please respond on or before June 5, 2012.

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1 Dear Families: Thank you for your interest in the MAChO program! Our summer program will run from Saturday June 30 through Saturday July 28, We will be selecting about 30 kids aged 8-13 to join the program this summer, so if you are interested we encourage you to return the form immediately. Enrollment is on a first come, first serve basis. Our website ( provides more information about the program. The core areas of focus are Nutrition, Fitness and. This summer, our program will take place at 119 th and 3 rd Avenue from 10 am to 2 pm on Mondays through Saturdays. Please ensure that your child will be available during these times before signing up for the program. If you know of any days that your child will be unable to attend, please state this on the application. Once we receive completed application forms, we will make calls to conduct a brief phone interview as part of the selection process. As a free program, we have a limited number of spaces available, so we encourage you to apply immediately and to be available for a brief phone conversation. Once accepted, you will then be asked to fill out necessary document to enroll your child in the MAChO program. Should you have any more questions, please call (347) or (212) or us at machoprograminfo@gmail.com. You may also request to receive an application by if you would prefer. Please respond on or before June 5, Sincerely, MAChO Team MAChO Program, A Community Service Program at Weill Cornell Medical College. 445 E 69 th Street #208, New York, NY Tel: (347) machoprogram@gmail.com

2 MAChO: Motivating Action through Community Health Outreach 2012 APPLICATION Part I: Child s Name: Date of Birth: Parent s/guardian s Name: Relationship: Parent s Phone Number: Address: Names and ages of other children: Part II: How did you find out about MAChO? Why would you like to enroll your child(ren) in MAChO? What do you expect them to learn in this program? What factors do you think are necessary for kids in your community to live healthy lives? What obstacles do you think keep kids in your community from living healthy lives? Will you be willing to participate in MAChO activities aimed towards parents roughly once a week? Thank you for your time! If you have any questions please call or machoprograminfo@gmail.com

3 Do you feel confident that your child can attend all sessions? Are there any dates that you know of in advance that your child will be unable to attend? How will you ensure that the lessons learned through MAChO are reinforced at home? When will be a good time to call you for a quick phone interview as part of the application process? Please indicate available days and times: Best number to call: Part III: MAChO relies on referrals to grow and to continue to spread our message of healthy living. If you know of others who will benefit from this program, please provide us with the information below. #1 Child s Name: Date of Birth: Parent s/guardian s name: Contact number# Contact Contact Address: Any special reason for referral?: What is your relationship with this referral? #2 Child s Name: Date of Birth: Parent s/guardian s name: Contact number# Contact Contact Address: Any special reason for referral?: What is your relationship with this referral? #3 Child s Name: Date of Birth: Parent s/guardian s name: Contact number# Contact Contact Address: Any special reason for referral?: What is your relationship with this referral? Thank you for your time! If you have any questions please call or machoprograminfo@gmail.com

4 MAChO June 30-July Sunday Monday Tuesday Wednesday Thursday Friday Saturday SATURDAY JUNE 30 MAChO Summer Session Begins ORIENTATION Class #1 Introduction, Icebreakers Class #2 Energy Part 1 Systems NO CLASS 4 th of July Class #3 Energy Part 2 Digestive System Class #4 Carbohydrates Session # Class #5 Protein Muscles Class #6 Nutrition Fat Heart Health Field Trip Class #7 Vitamins/Minerals Bones & Calcium Class #8 Advertising Session # Class #9 Drink Wars Diabetes Class #10 Food Groups Lungs Field Trip Class #11 My Plate Brain Class #12 Design My Plate Session # Class #13 Balance/Portions Exercise Routine Class #14 Review Games, Jeopardy Field Trip Class #15 Summer Enrichment Review Class #16: Graduation

5 Estimada Familia: Gracias por su interes en el programa de MAChO! Nuestro programa de verano sera desde Sabado, Junio 30 hasta Sabado, Julio 28, Adjunto se encuentra un folleto con informacion sobre nuestro programa y una aplicacion que used debe llenar indicando su interes. Escogeremos aproximadamente 30 ninos entre 8-13 anos de edad para nuestro programa de verano, por favor devuelva la aplicacion lo mas pronto posible. En nuestra pagina web ( usted podra obtener mas informacion sobre nuestro programa. Nuestras areas de enfoque son la Nutricion, Salud Fisica, y Desarrollo. Este verano, nuestro programa tomara lugar en la calle 119 y 3ra Avenida, en la escuela de Hunter College, de 10am-2pm de Lunes a Sabado. Por favor asegurese que que su hijo(a) estara disponible durante este horario antes de registrarlo(a). Si usted sabe que en elguna fecha especifica su hijo no podra asistir, por favor indiquelo en la aplicacion. Una vez que recibamos las aplicaciones, haremos llamadas para hacer una breve entrevista telefonica, como parte de el proceso de seleccion. Al ser un programa gratis, solo podemos seleccionar uan cantidad limitada de ninos. Le pedimos que aplique lo mas pronto possible y que este disponible para una entrevista telefonica. Una vez aceptado(a), usted debera llenar los documentos necesarios para registrar a su hijo(a) en el programa de MAChO. Si usted tiene alguna pregunta, por favor llamenos al (347) or (212) o por correo electronico: machoprograminfo@gmail.com. Tambien le podemos mandar la aplicacion por correo si lo desea. Sinceramente, Por favor responda antes de Junio 5, 2012 Equipo MAChO MAChO Program, A Community Service Program at Weill Cornell Medical College. 445 E 69 th Street #208, New York, NY Tel: (347) machoprogram@gmail.com

6 MAChO: Motivating Action through Community Health Outreach APPLICACION 2012 Part I: Nombre del Nino(a): Fecha de Nacimiento: Nombre de Padre/Guardian: Relacion: Numero de telefono: Correo Electronico: Direccion: Nombres y edades de otros ninos: Part II: Como se entero del programa MAChO? Porque le gustaria que su hijo(s) esten en el programa? Que espera usted que ellos aprendan en este programa? Que factores cree usted que son importantes para que los ninos en su comunidad vivan una vida mas saludable? Que obstaculos cree usted existen en su comunidad que no permite que los ninos vivan una vida mas saludable? Estaria usted dispuesto(a) a participar en talleres familiares por lo menos una vez por semana? Thank you for your time! If you have any questions please call or machoprograminfo@gmail.com

7 Esta usted seguro que su hijo(a) puede atender todas las clases? Hay alguna fecha que usted cree que no podra asistir? Como se asegurara usted de que lo que su hijo(a) aprenda en el programa sea reinforzado en la casa? Cuando es mas conveniente para llamarlo(a) para hacerle una breve entrevista por telefono? Por favor indique dia y hora: Mejor numero para llamar: Part III: MAChO depende en referidos para crecer y continuar el mensaje de una vida mas saludable. Si usted conoce de otras personas que puedan beneficiarse de este programa, por favor proporcione la informacion aqui. #1 Nombre de Nino(a): Fecha de nacimiento: Nombre de padre/guardian: Numero de contacto: Direccion: Alguna razon especial por el referido? Cual es su relacion con este referido? #2 Nombre de Nino(a): Fecha de nacimiento: Nombre de padre/guardian: Numero de contacto: Direccion: Alguna razon especial por el referido? Cual es su relacion con este referido? #3 Nombre de Nino(a): Fecha de nacimiento: Nombre de padre/guardian: Numero de contacto: Direccion: Alguna razon especial por el referido? Cual es su relacion con este referido? Thank you for your time! If you have any questions please call or machoprograminfo@gmail.com

8 MAChO June 30-July Sunday Monday Tuesday Wednesday Thursday Friday Saturday SATURDAY JUNE 30 MAChO Summer Session Begins ORIENTATION Class #1 Introduction, Icebreakers Class #2 Energy Part 1 Systems NO CLASS 4 th of July Class #3 Energy Part 2 Digestive System Class #4 Carbohydrates Session # Class #5 Protein Muscles Class #6 Nutrition Fat Heart Health Field Trip Class #7 Vitamins/Minerals Bones & Calcium Class #8 Advertising Session # Class #9 Drink Wars Diabetes Class #10 Food Groups Lungs Field Trip Class #11 My Plate Brain Class #12 Design My Plate Session # Class #13 Balance/Portions Exercise Routine Class #14 Review Games, Jeopardy Field Trip Class #15 Summer Enrichment Review Class #16: Graduation

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