Registration Form

Dear Parents 'שי

In preparation for the next school year תשפ"ה 5785 - please register your daughter/s, before June 15th, so we can secure your daughter/s place in school.

Please note: Registration fee is $400, If registered prior to June 8th a discount of $150 per student will apply.

An additional $50 discount will be applied for any additional student.

In order to make it easier for you (and for the administration office) we are combining the registration form and the CEP/Title forms. The only form that you will need aside from this, is the signed tuition contract (and for first time MBCM students the Immunization form), This process will allow for greater efficiency.

Please don't delay the process so, you could benefit from the discount.

After June 8th, registration cost will be $400 per student.

Family name *

E-mail*

Select the amount of student you will be registering today. if you are registering more than one student, please fill in their info in the comments box below.*

1 Daughter2 Daughter3 Daughter4 Daughter

Please write Student/s full name and Entering grade*

Phone Number to contact in case of any issue*

Area Code Phone Number

Total amount for registration

$0.00

CEP/Income/Lunch/Title

Survey form

For chart to check eligibility, please click Here

Father full Name*

First Name Last Name

Mother full Name*

First Name Last Name

Number of individuals in family*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Base on the chart attached, are you eligible for Free and/or reduced meals program ?*

Not applicableYes

Family Income: $*

Click One*

YearlyMonthlyBy-weekly

Is Family gross income less than the amount on the July 1, 2022-June 30, 2023 chart for your family?*

YesNo

Is your family eligible for SNAP benefits (Supplemental Nutrition Assistance Program)?*

YesNo

If yes, SNAP case number. if not applicable - please fill in with "abc". Thanks*

Is your family receiving assistance under the TANF program (Temporary Assistance for Needy Families)?*

YesNo

If yes, TANF case number. if not applicable - please fill in with "abc". Thanks*

Is the student eligible to receive medical program assistance under the Medicaid program?*

YesNo

I certify that the above information is true.*

*

Month Day Year

at Hour Minutes

Payment method - Form

1) The Board of directors has made an executive decision, that the administration office should obtain credit card info for ALL parents.Therefore we will using the registration payment info for cc backup.

2) Unless you choose otherwise, we will use this cc info for tuition payment.
if you would like to give a different card for tuition payment, at your convenience please go to www.monseybcm.com/ccupdate to fill in the cc info for tuition charges. - PLEASE do this BEFORE August 5th.

3) Please select the check payment option ONLY if you will be paying with checks.

4) Please choose the payment option for school year starting from august 15th. Please note if you choose checks as your payment option, you must submit the checks to MBCM office BEFORE August 15, otherwise your CC will be charged.
For any payment issues please contact the administration office at [email protected] or 845 634 7400 #300

4) choosing other method please specify it (in the other option).
Please note - We are now able to accept zelle payments, with the condition that you send us a proof of a scheduled payment plan.

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

CVV - if not applicable please write 123*

Comments

Registration for 5785 is currently OPEN