CTeen Registration

Your details

Teen 1

Teen’s name Teen’s phone T-shirt size Grade

Gender Male Female

Membership

Per teen, for the full year. We offer the subsidized fee to any family that needs it, no questions asked.

Regular fee $399 Subsidized fee $299

Parents

Mother’s name Mother’s phone Mother’s WhatsApp number Mother’s email Father’s name Father’s phone Father’s WhatsApp number Father’s email

Home address

Is the teen’s biological mother Jewish?

YesNo

Are there any conversions or adoptions in the family?

YesNo

What are your goals for your teen in CTeen? Does your teen have any behavioral, allergy or medical conditions we should know about? I give permission for my teen to receive medical care in an emergency if I can’t be reached. I give permission for photos of my teen to be used, and accept the program’s liability terms. Comments

Send me updates about upcoming events