Information & Registration

Dates: September 10, October 10, October 27, November 11, December 5, January 21, February 13, March 13, April 17, May 11, June 5
Time: 7:00 pm (some times may vary)
Program Fee: $180 per year (excludes regional trips and NY trip)

Teen INformation
First Name Last Name Mailing Address
City, State, Zip Cell
Home Phone Hebrew Name Date of Birth
School Attending Grade Best Contact
Parent's INformation
Father's Name Cell
Mother's Name Cell
Address City, State, Zip Home Phone
Payment Info
Expiration What's This?

Permission is hereby given for Chabad of Badenton & Lakewood Ranch CTeen to use in promoting CTeen and in other ventures directly relating to CTeen/Chabad (i) digital, photographic, video, and audio images or likenesses of teen member; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by the teen member or originating from CTeen or from a CTeen related activity.

Initials: Date: