Cteen Jr Calendar and Registration Teen Information Last Name First Name Hebrew Name Teen email (optional) DOB Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Nov. Dec. Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2002 2003 2004 2005 School Grade Entering Grade Entering Sixth Seventh Eighth Food allergies? yes no If yes, please specify: T-shirt Size Parent/Emergency Information Parent's Name Phone Number Email Address Emergency Contact Name: Emergency Contact Number: Photo Permission Photo Permission I understand that my child may be included in photographs and videos that may be filmed during events. I authorize Chabad Jewish Center to use these photos/videos to promote its programs and services in print, web, and other promotional content. Payment $250 covers all meetings for the year with a no-turn away policy due to lack of funds.* Tuiton Plans: $250 in full upon registration 2 payments of $125 (upon registration and December 1) $20 per event I would like to make other financial arrangements. *For financial arrangements, please contact Rabbi Zalman at 704-648-7966 or [email protected] Method of Payment CC Type Please Select Visa Mastercard Amex Discover Card Number Billing Address City, State, Zip CVV Exp Date Checks can be made to Chabad Jewish Center and write cteen jr. in the memo. This page uses 128 bit SSL encryption to keep your data secure.