2022 Legacy Summer Camp Registration Form

1
General Camp Information

June 6, 2022 - July 29, 2022

7:30AM-5:30PM

All federal holidays will be observed.

Office Phone: 256-777-4224

Pricing:

Registration Fee is $35 (First month payment is due by May 22, 2022)

$500/month for one child

$450/month each for two or more children

$100 off entire summer if both June and July are paid before May 22, 2022
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Child's Information
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Child's Name
First Name
Last Name
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Invoice ID
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Birth Date
Month
Day
Year
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The School Your Child Will Attend During 2022-23 School Year
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Upcoming Grade
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
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Gender
Male
Female
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Please Choose 2 Extracurricular ActivitiesEach child has the choice of two extracurricular activities sponsored by Maitland Conservatory and Elyon's School of Dance. All students will engage in one community service project a week, followed by a field trip and take gardening courses from Alabama A&M University Cooperative Extension.
Ballet
Piano
Art Expression
Vocal
Strings
Culinary
Audio/Visual
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Shirt Size
Youth Small
Youth Medium
Youth Large
Youth X-Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
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Parent/Guardian Information
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Guardian 1 Name
First Name
Last Name
14
Cell Number
15
Work Number
16
E-mail
example@example.com
17
Preferred Method of Contact
Call
Text
Email
All of the Above
18
Guardian 2 Name
First Name
Last Name
19
Cell Number
Please enter a valid phone number.
20
Work Number
Please enter a valid phone number.
21
Preferred Method of Contact
Call
Text
Email
All of the Above
22
Emergency Contact Information
23
Emergency Contact's Name
First Name
Last Name
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Relationship
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
25
Phone Number
26
Alt. Phone Number
27
Authorized Person 1
First Name
Last Name
28
Phone Number
Please enter a valid phone number.
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Relationship to Child
30
Authorized Person 2
First Name
Last Name
31
Phone Number
Please enter a valid phone number.
32
Relationship to Child
33
Unauthorized Individual's Name 1If not applicable, type "N/A"
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Relationship to Child
35
Unauthorized Individual's Name 2If not applicable, type "N/A"
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Relationship to Child
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Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.
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Any additional information?
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Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by The Legacy Center during summer camp. In exchange for the acceptance of said child’s candidacy by The Legacy Center, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Legacy Center and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against The Legacy Center including all teachers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
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Media Release I hereby grant permission to The Legacy Center and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release The Legacy Center and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given durning an interview or video, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.
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Transportation Authorization The parent of the above registered child gives authorization allowing the child to be transported to The Legacy Center's scheduled field trips.
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Confirmation BY ACKNOWLEDGING AND SIGNING, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Signature
Clear
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ORDER SUMMARY
Total costUSD
Legacy Summer Camp RegistrationRegistration fee will hold a space for one child, until the June payment due date of May 22nd.
$35.00Edit
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K-1st Grade
K-1st Grade
2nd-3rd Grade
4th-5th Grade
Grade Class
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Quantity
June TuitionTuition includes daily reading and math enrichment, the selection of two art-based lessons from Maitland Conservatory and Elyon's School of Dance, a weekly community service project, all field trips, and gardening courses. Also, continental breakfast, lunch and two snacks are also included.
$500.00Edit
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July TuitionTuition includes daily reading and math enrichment, the selection of two art-based lessons from Maitland Conservatory and Elyon's School of Dance, a weekly community service project, all field trips, and gardening courses. Also, continental breakfast, lunch and two snacks are also included.
$500.00Edit
Back
Full Summer Tuition DiscountPaying both month's tuition grants a $100 discount. Tuition includes daily reading and math enrichment, the selection of two art-based lessons from Maitland Conservatory and Elyon's School of Dance, a weekly community service project, all field trips, and gardening courses. Also, continental breakfast, lunch and two snacks are also included.
$900.00Edit
Back
2 or More Children Tuition DiscountTuition includes daily reading and math enrichment, the selection of two art-based lessons from Maitland Conservatory and Elyon's School of Dance, a weekly community service project, all field trips, and gardening courses. Also, continental breakfast, lunch and two snacks are also included.
$450.00Edit
Back
Total cost $0.00
Payment Methods
Credit Card
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