CTeen | Current Students

Ready for Another Amazing Year?

CTeen at Chabad at Midtown Miami is a welcoming and energetic community where Jewish teens come together to connect, grow, and make a difference. Through fun social events, meaningful volunteer projects, and exciting Jewish experiences, teens build friendships, explore their heritage, and develop a strong sense of purpose and pride. It’s more than just a program- it’s a place to belong, to lead, and to be inspired.

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

What we offer:
- Weekly get together + Hebrew School volunteering, Sundays 10am-12pm
- Fun events and trips
- A chance to connect with other Jewish teens!
Yearly CTeen membership fee: $300
Please Select*

I am a teenI am a parent applying for my teenage child
Teen Information
Full name*
First Name Last Name
E-mail*
Mobile Number

Area Code Phone Number
PARENT INFORMATION
Full Name* Parent submitting
First Name Last Name
Parent E-mail*
I would like to receive news and updates by email
Phone Number

Area Code Phone Number
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.
Full Name* Spouse name
First Name Last Name
E-mail* Spouse e-mail
Full Name*
First Name Last Name
E-mail*
Please indicate any change in address, email or phone #s from last year
Teen Information
How many are you registering for?*
up to 3
Full Name*
First Name Last Name
Hebrew name*
Mobile Number*

Area Code Phone Number
E-mail*
Grade entering*
School*
Second Teen
Please indicate*

Current StudentNew Student
Full Name*
First Name Last Name
Hebrew Name*
Cell Number*
E-mail*
Date of Birth*

Month Day Year
Gender*

BoyGirl
Previous Jewish Education*

YesNo
Where?*
Grade entering*
School*
Tell us about your teen! What are some hobbies or unique interests that make your teen who they are?*
Third Teen
Please indicate*

Current StudentNew Student
Full Name*
First Name Last Name
Hebrew Name*
Cell Number*
E-mail*
Date of Birth*

Month Day Year
Gender*

BoyGirl
Previous Jewish Education*

YesNo
Where?*
Grade Entering*
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
Please explain*
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
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 an environment in which your child(ren) can thrive)*

YesNo
Please explain* Indicate names if submitting for multiple children
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 Youth to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. I acknowledge that the Chabad Youth personnel shall not be held liable for any injury, loss, damage, or expense arising from or related to participation in any program or activity. It is understood that if time and circumstances reasonably permit, Chabad Youth 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 Youth 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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Ready for Another Amazing Year?

Teen Information

PARENT INFORMATION

Teen Information

Second Teen

Third Teen

Emergency Contact