HAVEN ACADEMY

Student Registration

Please enter the information below to begin. You will need to fill out an online registration packet for each student that is enrolling in Mott Haven Academy. You can expect to spend approximately 15 minutes on this process for each student. The information you enter can be saved so you may return to the form to complete it at a later time, if needed.

Parent/Guardian Name*

Student Name*
Grade Entering*

HAVEN ACADEMY STUDENT REGISTRATION

Select or Un-select Forms to be Completed*

STUDENT REGISTRATION

Student Information:

Student Name*
Birth Date*
Current Grade*
Grade Entering in September*
Gender*

For new students only:


Previous School*
This student*
What languages are spoken in your home-check all that apply*

Parent or Guardian Information


Parent or Guardian Information:*
Father Name*
Mother Name*
Guardian, Family Member*
Street Address*

Important: Please update the main office with any address and phone number changes.

EMERGENCY CONTACT INFORMATION

Student's Name*
Date of Birth*

Parent or Guardian Information

Parent or Guardian Name*
Add Another Parent/Guardian*
Parent or Guardian Name*
In case of an emergency, my child may be released to the following individual(s): (Emergency Contact #1)*
In case of an emergency, my child may be released to the following individual(s): (Emergency Contact #2)*
Add Another Emergency Contact?*
You must provide 2 emergency contacts
In case of an emergency, my child may be released to the following individual(s): (Emergency Contact #3)*
Is there an order of protection or other court documentation restricting contact against this person?*
(If yes, must obtain court documents.)

* If there are dismissal concerns, please contact the main office about a Dismiss with Caution Form.

Acknowledgement*
Use your mouse or finger to draw your signature above
Name of Signer*

DISMISS WITH CAUTION

Student Name*
Date of Birth*
Is there a court order/agency order limiting contact between this person and your child? (If yes, must obtain court documents.)
If yes, must obtain court documents
Is there a court order/agency order limiting contact between this person and your child? (If yes, must obtain court documents.)
If yes, must obtain court documents
Acknolwedgement*
Use your mouse or finger to draw your signature above - The recommendations of the parent as indicated will be respected as far as possible, especially if there is no court order. I understand that it is my responsibility to update the school with any changes.
Name of Signer*

PICK UP PERMISSION FORM

Below please list those who are authorized to pick up your child from Haven Academy. Written or verbal permission must be obtained before releasing your child to anyone NOT listed below. If your child has permission to walk home by themselves, please check and sign that at the bottom of the page. Please update this list as necessary.

Student Name*
Grade*
My child has permission to walk home alone*
Use your mouse or finger to draw your signature above
Name of Signer*

School Uniform Information

Student's Name*
Grade*

Haven Academy is a uniform school. All scholars are expected to be in full uniform every day with the Haven Academy logo showing. Grade level information is below.

A couple of other notes about uniforms:

  • We are a no hoodie school. We encourage you to purchase a couple of long sleeve shirts or button up sweaters/zip up sweatshirts without hoods.
  • When purchasing a backpack, ensure that it does not have wheels on it. For safety reasons, all backpacks should be carried on your back.
  • If you are purchasing sneakers, ensure that they do not have lights or wheels on them.


Little Haven – Pre-K

  • Uniform Company: Student Styles
  • www.yourstudentstyles.com
  • Top: Little Haven T-Shirt (orange, lime, pink, purple, blue)
  • Bottoms: Blue bottoms (sweatpants, pants, jumpers, skirts)
  • NO JEANS ALLOWED
  • All incoming families will receive 3 free shirts. Families are responsible for providing
  • the blue bottoms.
  • What size do you anticípate your child wearing in August?
  • 4T 5T XS S


Elementary School (K-5)

  • Uniform Company: Corey Uniform
  • www.coreyuniform.com
  • Student Styles – only purple, orange, and red shirts
  • www.yourstudentstyles.com
  • Top: Haven shirt with embroidered logo
  • (gold, purple, royal blue, pink, jade, lime green)
  • Bottoms: Khaki bottoms (pants, skirts, jumper)
  • All incoming families will receive 5 free shirts. Families are responsible for providing khaki bottoms.
  • What size do you anticípate your child wearing in August?
  • Small (7-8) Medium (10-12) Large (14-16) X-Large (18-20)
LITTLE HAVEN PRE-K: All incoming families will receive 3 free shirts. Families are responsible for providing the blue bottoms. What size do you anticípate your child wearing in August?
ELEMENTARY SCHOOL (K-5): All incoming families will receive 5 free shirts. Families are responsible for providing khaki bottoms. What size do you anticipate your child wearing in August?
Acknolwedgement*
Use your mouse or finger to draw your signature above
Name of Signer*

2020-2021 School Uniform Information

All Haven Middle scholars should be in full uniform every day. If a scholar is not in uniform, they will be sent home to change. As a reminder, the necessary uniform pieces include dark grey pants or skirts, and a Haven shirt. The Haven cardigan, sweater vest, and fleece are optional, but they are the only sweaters that may be worn. Jeans, leggings, sweats and hoodies are NOT permitted on uniform days. Attached is our Uniform Policy for your reference.

Haven Academy will provide each scholar with a pinstripe oxford, 2 polo shirts, and a tie. Families are responsible for the dark grey bottoms. Please indicate your child’s size:*

Important: Click here to download complete school uniform information sheet. This sheet contains ordering instructions for ordering uniforms online.

https://www.abcenroll.com/havenacademy-school-uniform-information.html

SCHOOL FIELD TRIP PERMISSION

Student Name*
During the school year, your child’s class will be taking frequent field trips during the regular school day that complement the academic learning in the classroom. Students will be traveling via yellow school bus, public transportation, and walking. Students will be accompanied by Haven Academy personnel as well as volunteer chaperones. Notices will be sent home from the school and/or your classroom teacher to notify you each time a trip will be taking place. If in the event a student does not have a signed permission slip for a particular trip, Haven Academy reserves the right to grant the child permission for field trip participation based on this form.
Use your mouse or finger to draw your signature above
Name of Signer*

PHOTO RELEASE FORM

Please be advised that your child may be photographed or videotaped at various school sponsored events. By giving consent, I understand that these photographs may be used in promoting Haven Academy in print, on the Internet, or videos/news. I understand that it is my responsibility to update this form in the event that I no longer wish to authorize the use of my child’s photos.

Student Name*
Date of Birth*
Photo Release *
Please select one
Use your mouse or finger to draw your signature above
Name of Signer*

NYC PARKS RECESS PERMISSION

Student Name*
Date of Birth*

During the school year, when weather permits, your child’s class will walk to Ranaqua Park located at East 136th Street between Brown Place and Willis Avenue for daily outdoor recess play. Students will be accompanied by Haven Academy personnel as well as volunteer chaperones.

During the winter, when there is snow on the ground, only students with boots and snow pants/suits will be allowed to play at the park. All other students will play indoor games during the recess time.

Statement of Permission: 

I give my child permission to participate in outdoor recess and activities at Ranaqua Park. I acknowledge that this play area is not owned or maintained by Haven Academy and I hereby release and discharge Haven Academy and The New York Foundling and its staff members from liability in the event of any injury or accident that involves my child. I also give permission and consent for any emergency medical treatment for my child as deemed necessary by qualified Personnel, including treatment at the nearest clinic or hospital.

Parent or Guardian Signature
Name of Signer*

STUDENT SUPPORT SERVICES QUESTIONAIRE

Student Name*
Date of Birth*

At Haven Academy we are dedicated to the success and development of every child. The following information you provide will help us plan appropriately to meet your child’s academic and social development needs. This information will not be used to label, separate, or exclude your child from any school or classroom instruction, activities, or events.

This student IS in Foster Care*
This student WAS in Foster Care*
This student receives Prevention Services*
This student is living in transitional housing*
This student has an Individualized Education Plan (IEP)*
If yes, please provide a copy of the IEP to Haven Academy.
*This student receives/has received the following services: (check all that apply)*
Has the student been retained?*
Use your mouse or finger to draw your signature above
Name of Signer*

STUDENT MEDICAL INFORMATION

Student Name*
Date of Birth*

Please provide the most recent up to date information about your child’s allergies, asthma, and any other medical conditions and medications required to be given during school hours. If your child has no allergies or medical issues, please write “NONE” on all appropriate lines.

Asthma*
If yes, is medication necessary?*

* 504 Form must be filled out by student’s physician and returned. The form, along with a photo of the child, will be kept on file in our school nurse’s office in order for medication to be dispensed.

Does the child wear glasses?*

UPLOAD DOCUMENTS

Important: What you need to register! 

  • Proof Of Birth: Child’s birth certificate, passport, or record of baptism which includes the date of birth, or other official document of age
  • Immunization records: Clear copies of the yellow card or immunization records provided by your MD office.
  • Educational Records: Latest report card/transcript (if transferring from another school)
  • Individualized Education Program (IEP) and/or 504 Accommodation Plan (if applicable)
  • Custody Records/Order of Protection: If there are any applicable custody orders, agency letters or Order of Protection, please provide to the office. We will keep this confidential.
  • Proof of Address (provide one): Proof of address which may be verified by any two of the following containing the address of residence:
  • A lease agreement, or mortgage statement for the residence
  • A residential utility bill (gas or electric) in the resident’s name issued by a utility company dated within the past 60 days
  • A bill for cable television services provided to the residence; must include the name of the parent and the address of the residence and be dated within the past 60 days
  • Documentation or letter on letterhead from a federal, state, or local government agency, including the IRS, the City Housing Authority, Human Resources Administration, the Administration for Children’s Services (ACS), or an ACS subcontractor indicating the resident’s name and address, must be dated within the past 60 days
  • Rent receipt which includes the address of the residence, must be dated within the past 60 days
  • State, city, or other government issued identification (including an IDNYC card), which has not expired and includes the address of residence
  • Income tax form for the last calendar year
  • Official NYS Driver’s License or learner’s permit which has not expired
  • Official payroll documentation from an employer issued within the past 60 days such as a pay stub with home address, a form submitted for tax withholding purposes or payroll receipt (a letter on the employer’s letterhead is not adequate); must include home address and be dated within the past 60 days
  • Voter registration documents, which include the name of the parent and the address of residence
  • Evidence of custody of the child, including but not limited to judicial custody orders or guardianship papers documents issued within the past 60 day with name of child and address of residence


Upon completion of your online registration please email Kiersten Ott at kott@havenacademy.org to verify your online registration and documents.

Select documents to upload
Proof of Birth*
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Immunization Records*
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Educational Records*
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Custody Records/Order of Protection*
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Proof of Address*
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Other Documents*
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