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Registration Form

Registration for 5787 is currently Open
Registration Fee:
- $400 per student
- A $150 early registration discount will apply if registration is completed by June 22nd.
- An additional $50 discount will be applied for each additional student from the same family.
- For more general info regarding registration please here.
Family name*
Select the amount of student you will be registering today. *

1 Daughter2 Daughters3 Daughters4 Daughters
Student First name*
First Name Grade
2nd - Student First name
First Name Grade
3rd - Student First name
First Name Grade
4th - Student First name
First Name Grade
Preferred Email for School Communication*
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*

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
Tuition Payment Policy
MBCM requires tuition payments to be made by credit card. The credit card information provided on this form will be used to process tuition payments. If you are unable to pay by credit card, please contact the Administration Office promptly to discuss alternative payment arrangements. The credit card information will be retained as a backup payment method.

📧 [email protected]
☏ Office Phone - 845 634 7400 #102
📲 cell - 845 430 8342

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

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Registration for 5787 is currently Open