Printed fromJewishLH.com

ב"ה

CTeen Registration Form

CTeen Registration Form
CTeen is open to all Jewish teens
We meet every few weeks for the duration of the school year with dinner and activities at each event! Plus trips, community service programs, social events, and Shabbat dinners throughout the year! You can find all of the CTeen dates for the 2018-2019 year Here.
Become a CTeen Member and enjoy all these benefits:
- Includes all regular sessions
- Discounts for all larger events and regional events
- Discount for International Shabbaton
Looking forward to an awesome fun-filled year together!
Student Info:
Full Name* Give more details here
First Name Last Name
Hebrew Name*
E-mail* Email Address
Cell Number*

Area Code Phone Number
Birth Date*

Month Day Year
Current School*
Grade*
Best form of contact

TextFacebookInstagramPhoneEmailSnapchat

Address*

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

Parents Info
Parent Name*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*
Other Information
Are the natrual parents of child Jewish

FatherMotherBoth
Were there any conversions or adoptions in your family?

FatherMotherPaternal GrandmotherMaternal Grandmother
Please Explain
Questions or comments:
Payment
Fee for year:

$89.99
Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

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

This page uses TLS encryption to keep your data secure.

Programs