Registration - Chabad Lubavitch of Tampa Bay

Cteen & Cteen JR Annual Registration
School Year 2021-22
Membership is required in order to join monthly meetings and events.
Cteen Annual Fee: $50
Cteen Junior Annual Fee: $100
Trips may require an additional fee.
Teen Name*
Hebrew Name
Teen Cell
Area CodePhone Number
Teen E-mail
Gender*
Grade*
Biological Mother*
Were there any conversions or adoptions in your family*
Emergency Contact*
Do you have friends that are interested in Cteen?
Mothers Name
Mothers E-mail*
Mothers Phone Number
Area CodePhone Number
Fathers Name
Fathers E-mail
Fathers Phone Number
Area CodePhone Number

Payment*

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Cteen & Cteen JR Annual Registration