Register

Hebrew School of the Arts
Registration Form 2025-'26
Parents' Information
Father's Name*
First Name Last Name
Father's Email
Father's Cell*

Area Code Phone Number
Father's Work

Area Code Phone Number
Mother's Name*
First Name Last Name
Mother's Email*
Mother's Cell*

Area Code Phone Number
Mother's Work

Area Code Phone Number
Check which apply:*

Mother born JewishMother converted - jewish orthodox conversion

Address*

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

Family that referred me:
Child's Information
Child: Name*
First Name Last Name
Child Hebrew Name:
Birth Date*

Month Day Year
Time of Birth (please refer to birth certificate to help us figure out the Hebrew birthday!)
Grade*
School*
School Address*
Does your child have special needs we need to know about?**

YesNo
If yes, please indicate which child, what's the diagnosis, and if he or she has a para
Please list any allergies or medications the child is taking.*
Emergency Information
Doctor's Name*
Phone Number*

Area Code Phone Number
Emergency Contact*
First Name Last Name
Relationship to Child*
Emergency Cell*

Area Code Phone Number
Emergency Home

Area Code Phone Number
Authorized to Pick Up*

ParentEmergency ContactOther
Pick up's Number

Area Code Phone Number
Authorization
I hereby give permission for my child to be transported to and from field trips, and to participate in them in all Hebrew School activities. I understand that during the course of Hebrew School my child can be hurt. I accept the risk of possible injury and authorize any member of the Chabad of Bensonhurst staff to render any necessary first aid. Furthermore, in an emergency case, I hereby authorize Mintcha hertz or another staff member to have my child taken care of by a physcian or other medical person in any way the situation calls for.
Transport/Emergency Care as listed above*

I give permissionI don't give permission
Initial Here
I give permission to Chabad of Bensonhurst and Hebrew School of the Arts, and those authorized by Chabad, to take photographs and to make recordings of my children and my family, and to use them in original or modified form in all media now or hereafter known, with or without my name or information about me, for the promotion, public education, and/or fundraising activities of Chabad of Bensonhurst.
Media Authorization*

I give permissionI don't give permission
Initial Here
Payment Options
For other payment options, please call (347) 277-5040
Scholarships Available.
Choose Payment Option:*

Pay full amount today - $900 (includes dinner and local transportaion)Pay in 2 installments ($450 today and $450 on Nov. 20th)
(If choosing to pay in 2 installments, the second payment will automatically be deducted on November 20th.)

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

Total Amount $

$0.00
I would like to receive news and updates by email
Should be Empty:

This page uses TLS encryption to keep your data secure.

Hebrew School of the Arts

Registration Form 2025-'26

Parents' Information

Child's Information

Emergency Information

Authorization

Payment Options