LEGACY PS 118Q 2026-2027 MEMBERSHIP FORM

General Information:

Legacy is the proud contract provider of after-school programs for The Lorraine Hansberry School PS118Q. Our programs are designed to provide continuous after-school child care for scholars in Prek-5th grades.

Our programs take place inside the school building. The program runs Monday- Friday from school dismissal until 5:45 pm.

Monday- Friday: Scholars receive a light snack, homework assistance, and then participate in arts & crafts, group activities, STEM, free play, and organized sports activities.

Program Hours:

The first day of After School will be: September 15, 2026.

Monday- Friday

Dismissal: 5:15 pm- 5:45 pm

Early Dismissal Slots: ( BY REQUEST)

3:30-3:40 PM

4:30-4:40 PM

Programs Closed:

October 15, 2026
October 22, 2026
Anticipated Last day of Programs: June 16th, 2027

- Legacy Office of Membership Management & Programs

Membership Plan Options for 2026-2027:

$215 per month for 5 days per week.
PreK students' monthly membership requires a $5 PreK Cohort add-on fee.
Sibling Discount is $20 off the monthly invoice.
By registering, you will be charged for the first month of care to get started. After that, you will be billed monthly and pay using the ProCare app.

Membership Details:

Sibling discounts will be applied after you have completed a form. The sibling discount is $20 per month and will be on your ProCare account starting in October or on the subsequent invoice.

This form is for one child at a time. If you need to add a sibling, please complete another form.

Select a start date:

Please choose the date you wish for your child to start after school.

Starting on a different date?

The membership will become active the day your child starts the program. For example, completing an application today secures the membership, and your child can start at any time you are ready for the care to begin; the month billing cycle will begin from that date. This application is first come, first served.

Vouchers:

Legacy ONLY accepts 1199 SEIU AND MTA LOCAL 100 vouchers. If you have a voucher or any form of tuition assistance, you will still need to complete an application at the full rate for the first month. Processing of vouchers will begin after the first month of care.

Procare:

Every registering parent is required to download the Procare app. You will receive a text and/or email with the sign up/ download information. Note: It can take up to 3-5 business days for the application to be processed and receive the ProCare app download link.

Communication:

Please enter an email that you check regularly. Verify you entered the correct spelling of the email addresses below.

Next:

You will receive an email to sign the Membership Agreement. This agreement is required, and your application is not finalized until this agreement is signed.

Note:

It takes three- five business days to fully process and review your application. During this time, the first month's membership will be charged as stated below. As the first day of school approaches, additional information will be sent to you in preparation for after-school starting.

Additional Questions? Your child's school does not manage enrollment and/or membership concerns.

Email us: membership@legacyafterschool.com

Oh no!:

Unfortunately, there are no refunds. Your payment is non-refundable according to the Membership Policy.

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Child's Full Name

First NameLast Name

Date of Birth

Date

Gender

Grade Entering in Fall 2026

Was Your Child Enrolled in Legacy After School Programs During the 2025-2026 School Year?

Did Your Child Attend Legacy Summer Camp This Summer 2026?

Select the date you wish for your child to start after school.

Date

Primary Parent/Guardian Full Name

First NameLast Name

Relationship to Child

Other

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Parent Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Primary Parent Work Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Primary Parent Email Address

example@example.com

Parent/Guardian Full Name

First NameLast Name

Relationship to Child

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

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Authorized Parent/Guardian Full Name #1

First NameLast Name

Authorized Pick Up #1 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Authorized Parent/Guardian Full Name #2

First NameLast Name

Authorized Pick Up #2 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Does your child have any behavioral concerns we should be aware of?

If yes, please describe behavioral concerns

Has your child been diagnosed or recieve with any of the following services concerns? (Select all that apply)

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.

Does your child have any medical conditions?

If yes, please describe the medical condition(s)

Does your child take any medications?

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

Does your child require the use of an asthma inhaler?

Does your child have any allergies?

If yes, list all allergies and describe any reactions or Medications. Note: Legacy is a nut free program and self administering site.

Early Dismissal Plan- I am requesting that my child be dismissed at the time slot requested below.

Legacy Accepts Select Child Care Vouchers and Child Care Assistance. Will You be using vouchers listed?

SURVEY QUESTION: Which of the following Legacy programs would your family be interested in using during the school year?

How did you hear about Legacy? ( Friend Name, Google, Instagram, Community?)

By completing this order, you securing membership for the child above. If you have a second child, please complete another application. Payment is Final and Non Refundable.

2026- 2027 MEMBERSHIP APPLICATION FEE

This application fee is required.

$60.00

LEGACY MONTHLY MEMBERSHIP

This is the monthly membership care plan. Monday- Friday.

$215.00

ADMINISTRATIVE FEE

This Administrative fee is required for processing

$10.00

PreK Cohort Fee

This Fee is required if your child is in PreK.

$5.00

Total

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Legacy 2026–2027 After-School Program Registration Form- PS 118Q

Child Information

Primary Parent/Guardian Contact Information

Parent /Guardian Contact Information

Dismisal Process & Authorized Pick Up

Behavioral and Developmental Information

Medical & Allergy Information

Dismisal Plan

Parent Acknowledgments

FINALIZE MEMBERSHIP CARE PLAN

By completing this order, you securing membership for the child above. If you have a second child, please complete another application. Payment is Final and Non Refundable.

Payment Methods

Legacy 2026–2027 After-School Program Registration Form- PS 118Q

Child Information

Primary Parent/Guardian Contact Information

Parent /Guardian Contact Information

Dismisal Process & Authorized Pick Up

Behavioral and Developmental Information

Medical & Allergy Information

Dismisal Plan

Parent Acknowledgments

FINALIZE MEMBERSHIP CARE PLAN

By completing this order, you securing membership for the child above. If you have a second child, please complete another application. Payment is Final and Non Refundable. *

Payment Methods

By completing this order, you securing membership for the child above. If you have a second child, please complete another application. Payment is Final and Non Refundable.