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Registration

Please Select:*

I AM A TEEN (this registration is for me) MY TEEN (I am a parent, this registration is for my teen)
Teen's Information
Full Name*

First Name Last Name
E-mail*
Phone Number*

Area Code Phone Number

Address*

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

School*
Grade entering in September 2022*
Birthday*

Month Day Year
What is your preferred method of communication?*

FB Email Text Message All of the above
Two friends I would like to refer to CTeen (optional):
Friend 1

First Name Last Name
Friend 2

First Name Last Name
Size for CTeen Tshirt:
Is Your Mom or Dad Jewish?*

Mom Dad Both
How did you hear about CTeen?
Parent's Information
Mother's Name*

First Name Last Name
Mother's E-mail*
Mother's Phone Number*

Area Code Phone Number
Father's Name*

First Name Last Name
Father's E-mail*
Father's Phone Number*

Area Code Phone Number
Cteen Cares registration $100 (Fees will cover basic expenses for the program such as themed refreshments, supplies, transportation to locations of community service, Cteen T-shirt, and discount for the annual Cteen NY Shabbaton and regional trips)
Please select Track:*

Track 1: Monthly Club Track Track 2: Weekly at Hebrew School of the Arts
Total

$0.00

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