Legacy Youth Organization of Boston mission is to increase

the artistic performance and academic level of youth by

providing programs and opportunities that contribute to their

lifelong success. Legacy Boston is a branch of The Legacy Corporation

headquartered and founded in New York City in 2002 to

provide schools and communities with quality programs for

youth. Legacy is one of the largest providers of developmental

programs to youth serving thousands of students of NY & MA. Legacy breaks barriers and the cycle of poverty for low-

income youth and their families through our leading

educational, developmental, performing arts, and other

school based programs. We renew the minds & spirits of

young people through guidance exposure to the arts, higher

education and careers to open doors and opportunities. Our

programs inspire youth to succeed!

Who May Register? Legacy programs are open to all students K to 3

rd Grade and

are first come first served. Parents must READ and complete

this form carefully AND submit their registration payment.

Legacy AFTER SCHOOL programs are in session in the

Perkins school Monday- Thursday 2:30-5:45; children may be

picked up from the designated pickup room anytime from 5:45-

6:00 PM. Late Fees will apply for pickups after 6:00pm.

Families interested in BEFORE SCHOOL programming

please check that option on the registration form.

Siblings: If you have two or more children, you may qualify for

a reduced rate. Please complete forms for both children. We

will contact you regarding special rates.

Complete this form and enclose your check or money order

and send with your child to their teacher or bring your

forms into the main office.

Programs start Thursday, September 4

th and end in June. Legacy

is closed on days when public schools are closed, company

holidays or on half-days when all grades are dismissed early.

The LEGACY AFTER SCHOOL program will have the most

educational and performing arts programs this school year

available to your child. Each day of afterschool your child will

complete their homework, and participate in these great

programs:

Young Scholars Homework Help

Study Island Computer Hour

Fine Arts/ Arts & Crafts

Cub Scouts & Boy Scouts

Girl Scouts

Theater Club

Library & Literature Hour

Legacy After-School costs $20 to register for the year and $65 a

month per child. Membership fees are payable in full upon

registration.

Legacy accepts Money Order & Check payments written to:

LEGACY YOUTH ORGANIZATION You may register over the phone quickly by credit/ debit card.

Call us at: 917-830-5437

Drop-off Registration

Drop off your completed registration forms and check or money

order payment in a sealed envelope to the FCOC Ms. Evelyn Correa or the school main office.

Once the membership office processes your application and your registered, your child will be sent home with a

membership packet stating their registration is successful.

We will also call you and email you.

Registration is not complete unless you receive a

confirmation from our office.

Legacy Youth Organization After-School Program

Michael Perkins Elementary School

50 Rev Burke St. South Boston

212-873-0490 www.bostonafterschool.org General Information

Registration

After School Programs

AFTER SCHOOL FEES

OFFICE USE ONLY

APP-RECV: __/___/___ Mem# LB-______ P- DATE:___/___/___ APR/ DEN

PRINT CLEARLY IN BLUE/BLACK INK

Childs Name: _______________________________Last Name: ____________________ Birth Date: _________

Teacher:___________________________________________Grade:______________Room:__________

Address:_________________________________________ Apt. _____City: ______________Zip:____________

Home Phone: _________________ E-mail(s): _______________________________________________________

Parent/Guardians Name:________________________________ __Day Phone:_________________________

Parent/Guardians Name:_______________________________ ___Day Phone:_________________________

Emergency Contact Adult:_________________________________ Day Phone:_________________________

Please Circle:

Allergies or Special Needs? Yes No Is your child Asthmatic? Yes No IEP or any Behavior Issues? Yes No

The following adults are authorized to pick up my child (other than parent/guardian):

Name: _________________________________ Relationship: ________________ Phone: ____________________

Name: _________________________________ Relationship: ________________ Phone: ____________________

Please list names of people who MAY NOT pick up your child under any circumstances:

Name: _________________________________ Relationship: ________________ Phone: ____________________

Which days will your child attend After-School?

Monday Tuesday Wednesday Thursday

I Am Interested In Before School Programs

Registration Fee $20.00 Program Fee: $65.00 per Month

My Payment Options I agree to pay my childs monthly membership fee by the following method:

CHECK OR MONEY ORDER, made out to LEGACY YOUTH ORGANIZATION (ENCLOSED)

I wish to make a DONATION of $_________to Legacy to support. (ENCLOSED)

REGISTRATION IS NOT COMPLETE UNTIL PAYMENT IS RECIEVED

BRING THIS FORM TO THE MAIN OFFICE OR SEND TO FCOC

PLACE THIS FORM IN THE LEGACY CORP MAIL BOX

__

Legacy Youth Organization of Boston Perkins Elementary School Site

2014-2015 Membership Registration Form

Membership Registration Form

Membership Application Fee

+ Registration Fee: $20.00

+ After School Monthly Fee: $65.00

= Total Due with Application:$85.00 $100

Total DUE $ 50.00