Registration for Legacy Center 2020 Programs

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Once your registration is submitted and confirmed, you will be invoiced separately.

Email *

WELCOME

Thank you for your interest in our programs at the Legacy Center. This is our GENERAL REGISTRATION FORM and GENERAL RELEASE OF LIABILITY AND WAIVER. It will be applicable to all programs your son/daughter attends at the Legacy Center in the calendar year 2020.

Please complete this general form and submit it. We review each application to ensure that participant and program are a good match in terms of any supports that are needed or any unique needs that need to be addressed.

We ask that you complete this registration packet and provide payment in order to secure your spot. We are "safety first" conscious and will plan for an appropriate staffing ratio based on the number of participants, but also ask that parents consider the level of supervision and/or facilitation their participant requires. If help is needed to follow directions or more than general supervision is required to ensure safety, please plan on sending a facilitator with your participant.

Please contact Jacquie@theLCnet.com or (818) 458-1656 with any questions or concerns.

Please indicate the program for which you are registering. (e.g. Spring Camp, Art, Tutoring, etc...) Additional program information will be forthcoming. *

FAMILY INFORMATION

Please provide us with a little bit of information about your family.

Name of Parent

Address

Phone Number

PARTICIPANT INFORMATION

Please provide us with some insight into your son/daughter.

Full Name

Nickname

Age

Gender

Male

Female

Clear selection

Type of Participant

attending independently

attending with a facilitator (if your son/daughter needs assistance in following general directions, physically participating, or for safety concerns, we strongly urge attendance with a facilitator for maximum program benefit), we strongly

Option 3

Clear selection

If attending with a facilitator, facilitator name?

Does participant have any allergies?

Yes

Clear selection

If yes to allergies, please specify.

Please specify any dietary restrictions.

Is the participant currently on medication?

Yes

Clear selection

If yes to medications, please specify.

If yes to medications, will camper require medication during camp hours?

Yes

Clear selection

PARTICIPANT PROFILE

Please help us get to know your son/daughter prior to the beginning of our program

Please describe your participant's personality

What are your participant's three greatest challenges?

What are your participant's three greatest strengths?

How best can your participant be helped in a stressful situation?

Strategies you use to redirect or calm your participant when they are upset?

Is there anything else you would like to share with us about your participant?

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