Cteen Jr Calendar and Registration

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Teen Information
 
Last Name
First Name
Hebrew Name
Teen email (optional)
DOB
School
Grade Entering
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 zalman@jewishlouisiana.com 

Method of Payment
CC Type   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.