EmailMeForm
MBI-PAL/SCS Registration Form
(For Northaven & Hawkins Mills Parents Only)
Please complete the online form below. Registration fee is $10 per year. Registration fee is due at Orientation or on First Day. Once you submit this form, we will process it and will be in contact by phone or email with more information.
Scholar Name
*
First
Last
Birthdate
MM
/
DD
/
YYYY
Age
Gender
Male
Female
School Applying For
*
Please select
Northaven Elementary
Hawkins Mills Elementary
Grade
KK
1
2
3
4
5
Parent/Guardian 1- Name
*
Relation to Child
Permanent Address
Phone
*
###
-
###
-
####
Phone Type
Please select
Cell
Work
Home
Email
Parent/Guardian 2- Name
Relation to Child
Permanent Address
Phone
###
-
###
-
####
Phone Type
Please select
Cell
Work
Home
Email
Emergency Contact Name
*
Emergency Contact Phone
*
###
-
###
-
####
Please list any allergies or dietary restrictions
*
Please list any medical conditions we should be aware of
*
I am interested in:
*
Before Care-$15
After Care-$25
Both-$40
Please list those authorized to pick-up your child. Those listed will need to show ID.
*
1
2
3