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  • Kivun Registration Form 2020-21

  • Parents' Information

  • Child's Information

  • Emergency Information

  • Authorization

  • I hereby give permission for my child to be transported to and from field trips, and to participate in them in all Kivun activities. I understand that during the course of Kivun my child can be hurt. I accept the risk of possible injury and authorize any member of the Chabad of the West Side staff to render any necessary first aid. Furthermore, in an emergency case, I hereby authorize Chana 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. 

  • I give permission to Chabad of Bensonhurst and Kivun, 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. 

  • Schedule and Payment Options

  • Please select whether your child will attend once or twice a week:

  • Twice a week : $1200 for the year
    Once a week: $700 for the year

    Sibling Discount: 10% sibling discount for 2nd and 3rd children in the same family

    Ambassador Discount: Get another family to register for Kivun for the year, you will get $100 off your tuition!  


    Two days: $600 due by October 30, 2020  |  $600 due on January 15, 2021.
    One day: $350 due by  October 30, 2020  |  $350 due on January 15, 2021.
    Deduct 10% of total for second and third child.

    Credit Card
    Billing Address
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