Information & Registration

Dates: September 5, October 3, November 3, December 5, January 16, February 11, March 19, April 16, May 10, June 3
Time: 7:00 pm (some times may vary)
Program Fee: $200 per year (includes all trips and programs excluding NY Trip and end year CTeen 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: