Register for Kivun on Zoom - Chabad of Bensonhurst

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Family that referred me:
Child's Information
Child: Name*
First NameLast Name
Child Hebrew Name:
Birth Date*
MonthDayYear
School*
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.*
If no allergies or medication, please write "none"
Authorization
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.
Media Authorization*
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Initial Here*
Payment Information
$360 - From January 2022 through May '22.
For other payment options, please call (347) 277-5040
Scholarships Available.
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Discounted Price:(Only applies to those who have made prior arrangements with Administration)
$

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Kivun Zoom Registration 2021-22