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 [email protected] 

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.