CTeen

Reach Out To Join!

Discover the excitement of CTeen, where teens connect, grow, and lead within a vibrant community! Our dynamic program offers engaging activities, inspiring leadership opportunities, and a chance to build lifelong friendships while exploring Jewish traditions and values. Whether through social events, community service, or educational workshops, CTeen provides a welcoming space for personal growth and meaningful experiences.

What we offer:

- Monthly get-togethers on the first Monday of the month, 7pm-8:30pm
- Weekly Hebrew School volunteering opportunities
- A chance to connect with other Jewish teens!

Yearly CTeen membership fee: $70 (excluding trips)

Join us and be part of a community that celebrates your unique voice and encourages you to shine!
Teen Information
*

I am a teenI am a parent applying for my teenage child
How many are you registering for?*
up to 3
Your Name* Parent submitting
First Name Last Name
Teen 1 Full Name*
First Name Last Name
Hebrew name*
Date of Birth*

Month Day Year
Gender*

BoyGirl
Grade entering*
Previous Jewish Education*

YesNo
Where?*
Cell Number*
E-mail*
School*
Tell us about yourself! What are some hobbies or unique interests of yours that make you, YOU?*
Tell us about your teen! What are some hobbies or unique interests that make your teen who they are?*
Second Teen
Teen 2 Full Name*
First Name Last Name
Hebrew Name*
Date of Birth*

Month Day Year
Gender*

BoyGirl
Grade entering*
Previous Jewish Education*

YesNo
Where?*
Cell Number*
E-mail*
School*
Tell us about your teen! What are some hobbies or unique interests that make your teen who they are?*
Third Teen
Teen 3 Full Name*
First Name Last Name
Hebrew Name*
Date of Birth*

Month Day Year
Gender

BoyGirl
Grade Entering*
Previous Jewish Education*

YesNo
Where?*
Cell Number*
E-mail*
School*
Tell us about your teen! What are some hobbies or unique interests that make your teen who they are?*
Please describe your family's Jewish background/education (if applicable).
Is the biological mother of the Child(ren) Jewish?*

YesNo
Did the child(ren), their biological mother, or biological grandmother undergo any conversion process or adoption?*

YesNo
Please provide details* Indicate names if submitting for multiple children
Is your biological mother Jewish?*

YesNo
Did you, your biological mother, or your biological grandmother undergo any conversion process or adoption?*

YesNo
Please provide details*
Do you have any allergies or medical information we should be aware of?*

YesNo
Please describe them and indicate special precautions or care needed.*
Do you have an IEP or receive any behavioral or educational support in school? (Sharing this information with us enables us to create a Hebrew School environment in which you can thrive)*

YesNo
Please explain*
Do/Does your child(ren) have any allergies or special medical considerations?*

YesNo
Please describe them and indicate special precautions or care needed.* Indicate names if submitting for multiple children
Do/Does your child(ren) have an IEP or receive any behavioral or educational support in school? (Sharing this information with us enables us to create a Hebrew School environment in which your child(ren) can thrive)*

YesNo
Please explain* Indicate names if submitting for multiple children
Parents Information
Father's Name*
First Name Last Name
Father's Hebrew Name*
Father's Cell*

Area Code Phone Number
Father's E-mail*
Occupation*
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother's Cell*

Area Code Phone Number
Mother's E-mail*
Mother's Occupation*
Best way to send updates:*

Cell PhoneEmail
I would love to be a part of my child’s Jewish education! Please feel free to contact me if there are any opportunities to get involved.
I would like to receive news and updates by email
Home Phone*

Address* Please indicate your apartment/unit number if applicable.

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

Synagogue affiliated with (if any):
How did you hear about us?
Emergency Contact
Persons to be contacted in case of an emergency when parents cannot be reached. Please provide two contacts.
Contact 1*
First Name Last Name
Phone Number*
Relationship to child*
Contact 2*
First Name Last Name
Phone Number*
Relationship to child*
Payment Method*

Credit CardOther

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Please complete the form and make payment to:
- Zelle: [email protected]
- Venmo: @MidtownChabad
Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.*
Please check*

I accept.
Mother's signature*
First Name Last Name
Today's date*

Month Day Year
Father's signature*
First Name Last Name
Today's date*

Month Day Year
Teen's Signature*
First Name Last Name
Today's date*

Month Day Year
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Reach Out To Join!

Teen Information

Second Teen

Third Teen

Parents Information

Emergency Contact