Information & Registration

Dates: September 13, October 13, October 28, November 13, December 6, January 17, February 4, February 23-26, March 21, April 25, May 19, June 11
Time: 7:00 pm (some times may vary)
Program Fee: $200 per year (includes all trips and programs excluding 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: