LEGACY HARLEM SUMMER CAMP 2026 REGISTRATION FORM

Summer Camp 2026 Registration Form
Legacy is excited to welcome your child to the 2026 Summer Camp Season. This is the first step to enrolling your child! Please complete this form carefully by reading and reviewing all parts and questions!!

- Legacy Office of Membership Management & Programs

General Information

PreK. If your child will be four years old during camp, they will be placed in the Yellow Group. An additional $35 will be added to the session. This is a smaller cohort and requires additional staffing!

Broken Sessions: Going on vacation? Won't need consecutive two weeks, no problem! Click each session that has the dates your child will attend. No Worries, OMMP staff will sort all that out as we get closer to camp, at least by May 15, 2026.

Services: If your child typically receives speech or SEITT services and you may need accommodations during camp, please contact us first before completing this application.

Camp Shirts: Use this form to purchase additional shirts. Legacy provides one shirt for free. You can purchase shirts closer to camp as well but for organization purposes we suggest ordering it today.

Deposits: Your deposit is applied toward your selected sessions.

For Example:
If your child attends 4 sessions, the deposit is split evenly ($62.50 per session).
If your child attends 2 sessions, $62.50 is applied to the first session and the remaining $187.50 to the second.

Tip: Please put an email that you check regularly.

Next: You will receive an email to sign the Membership Agreement. Missing this slows evveerrything....

Last: Once you receive the email from Procare... Download the PROCARE App to your device. Once downloaded, your child is secure in camp! You can use ProCare messages at any time to communicate with the Membership Office!

Note: It takes 1-2 business days to fully process and review your application.

Oh!: Unfortunately, there are no refunds.

Additional Questions? Email us: membership@legacyafterschool.com

Follow us on Instagram! www.instagram.com/legacyyouthorg
Child Information

Please provide information about the camper.
Child's Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Grade Entering in Fall 2026*
Child's School*
Was Your Child Enrolled in Legacy After School Programs During the 2025-2026 School Year?*

YesNo
Did Your Child Attend Legacy Summer Camp In The Past?*

YesNo
Does your childs school need an After School Program?*

YesNoNot Applicable
Primary Parent/Guardian Contact Information

Who should we contact regarding this registration?
Primary Parent/Guardian Full Name*

First NameLast Name
Relationship to Child*

MotherFatherLegal GuardianOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Please enter a valid phone number.
Secondary Contact Phone Number ( Work)
Please enter a valid phone number.
Primary Email Address*
example@example.com
Parent /Guardian Contact Information

List The Second Guardian Here- If Applicable
Parent/Guardian Full Name

First NameLast Name
Relationship to Child

FatherLegal Guardian
I Want This Guardian To Have Permissions On My Childs Account.

YesNo
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Dismisal Process & Authorized Pick Up

Authorized pick-up individuals must be at least 16 years old. The authorized pick-up individual(s) entered below are allowed to pick up your child from Legacy. Guardians listed in the previous sections are automatically considered authorized pick-ups and they do not need to be included here.
Authorized Parent/Guardian Full Name #1*

First NameLast Name
Authorized Pick Up #1 Phone Number*
Please enter a valid phone number.
Authorized Parent/Guardian Full Name #2

First NameLast Name
Authorized Pick Up #2 Phone Number
Please enter a valid phone number.
Session Selection

Select all sessions your child will attend. Please note, you may choose the sessions even if unsure, selecting the sessions allows the space to be secured with your deposit to be charged with this application. Changes can be made up until: May 15, 2026.
Select Summer Camp Sessions*

Charter Session: June 22 - June 26, 2026: $310Session 1: June 29 - July 10, 2026: $400Session 2: July 13 - July 24, 2026: $400Session 3: July 27 - August 7, 2026: $400Session 4: August 10 - August 14, 2026: $310
Extended Day & Dismisal Plan Add-On Selection

Select all sessions your child will require Extended Day. You may choose more than one. Even if unsure, selecting the sessions allows the space to be secured. Note: The cost for Extended day is $50 PER session and will not be due until closer to when your child starts camp. Dropping or changes can be made up until: May 15, 2026.
Select the sessions you will need EXTENDED 8AM-5:45PM.

Charter Session: June 22- June 26Session 1: June 29 - July 10Session 2: July 13 - July 24Session 3: July 27 - August 7Session 4: August 10 - August 14
Early Dismissal Plan- I am requesting that my child be dismissed on non trip days:*

Early Dismisal: 4:30-4:40 PMGeneral Dismisal: 5:15-5:45 PMOther
Basketball Camp Specialities Add-On Selection

Select all sessions your child will join the Basketball Camp. Basketball is open to campers PreK- 6th grades and take place during the camp day everyday. You may choose any number of sessions you wish your child to participate. Selecting the sessions allows the space to be secured with your deposit. Note: The cost for Basketball Camp is $50 per session. Dropping or changes can be made up until: May 15, 2026.
Select Summer Camp Sessions*

Charter Session: June 22 -June 26Session 1: June 29 -July 10Session 2: July 13 -July 24Session 3: July 27 -August 7No Basketball Camp
Cooking & STEM Clubs Add-On Selection

Select all sessions your child will participate in for Club Programs. Clubs take place one day per week during the camp day. You may select any number of sessions. Selecting a session secures your child’s spot. Note: Club cost is $40 per and payment will be due closer to the first day of camp. Space is limited.
Select Club Add On Programing*

Charter Session: Cooking ClubSession 1: Cooking ClubSession 2: Cooking ClubSession 3: Cooking ClubSession 4: Cooking ClubCharter Session: STEM ClubSession 1: STEM ClubSession 2: STEM ClubSession 3: STEM ClubSession 4: STEM ClubNo Clubs
Camper Independence

Information about your child's habits and independence.
Is your child fully toilet trained?*

YesNo
Does your child require assistance in the bathroom? Note: your child must be independtly able to use the bathroom with minimal assistance.*

No, my child is independentYes, needs reminders onlyYes, needs significant assistance
Has your child had any bathroom accidents in the past 3 months?*

NoYes, occasionallyYes, frequently
Has your child attended any Summer Camp Program in the Past?*

Yes, and they loved itYes, mixed feelingsNot yet — this is a firstWe’re all learning together
Behavioral and Developmental Information

Help us understand any behavioral or developmental needs.
Does your child have any behavioral concerns we should be aware of?*

NoYes
If yes, please describe behavioral concerns
Has your child been diagnosed or recieve with any of the following services concerns? (Select all that apply)*

ADHDAutism Spectrum Disorder- Clinically DiagnosedSEIT/SEITTIEP (Individualized Education Program)504 PlanNone of the aboveOther
If applicable, please provide additional details about your child's diagnosis or support needs
To Best serve your child. The Legacy Office of Membership Management requires that you upload your child's IEP and or any documents that will provide support and understanding of your child while in programs.

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Medical & Allergy Information

Please provide details of any medical conditions or allergies.
New York State Law and NYC Dept of Health Code requires all children to have a physical and immunizations stamped and dated within the calendar year of camp. If you have your childs physical, please upload it now so it can be processed. Note: your child will not be able to start camp without a valid physical.

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Does your child have any medical conditions?*

NoYes
If yes, please describe the medical condition(s)
Does your child take any medications?*

NoYes
Does your child require the use of an epinephrine auto injector?*

NoYes
Does your child require the use of an asthma inhaler?*

NoYes
Does your child have any allergies?*

NoYes, food allergiesYes, medication allergiesYes, environmental allergies
If yes, list all allergies and describe any reactions or Medications. Note: Legacy is a nut free program and self administering site.
Parent Acknowledgments

Please review and acknowledge the following questions.
Legacy Accepts Select Child Care Vouchers and Child Care Assistance. Will You be using vouchers listed?*

I do not have a child care voucher.MTA LOCAL 1001199- CHILD CARE FUND
How did you hear about Legacy? ( Friend Name, Google, Instagram, Community?)*
FINALIZE SUMMER CAMP BOOKING

By completing this order, you are booking camp with a deposit for the child listed above. If you have a second child, please complete another application. Your first invoice payment will be due at least three weeks before the start of camp. *

2006 SUMMER CAMP DEPOSIT The deposit will be used to book sessions selected on the application.

$250.00

General Camper T-ShirtNote: Each camper will receive one camp shirt by default for free. This option is to purchase additional shirts. General Campers will be required to wear their shirt on trip days. We suggest ordering three shirts total for camp.

$20.00 QuantitySize

Basketball Camper T-Shirt Note: Campers who will be in Basketball will be required to wear their camper shirt daily while at camp. Legacy provides one by default for free. We suggest ordering three shirts total for camp.

$20.00 QuantitySize

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Should be Empty:

Summer Camp 2026 Registration Form

Child Information

Primary Parent/Guardian Contact Information

Parent /Guardian Contact Information

Dismisal Process & Authorized Pick Up

Session Selection

Extended Day & Dismisal Plan Add-On Selection

Basketball Camp Specialities Add-On Selection

Cooking & STEM Clubs Add-On Selection

Camper Independence

Behavioral and Developmental Information

Medical & Allergy Information

Parent Acknowledgments

FINALIZE SUMMER CAMP BOOKING

Payment Methods