Information & Registration

Dates: September 23, October 19, November 16, December 19, January 7, January 29, February 24-27, March 6, April 5, May 27, June 12
Time: 7:00 pm (some times may vary)
Program Fee: $180 per year (includes all trips and programs excluding NY Trip and partial Busch Gardens)

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: