CTEEN Boat Party (2).jpg 

REGISTRATION INFO REMAINS STRICTLY CONFIDENTIAL:  

 Your Teen's info

Name
Last
Hebrew Name Male Female
Date of Birth
School
Grade Entering

What goals would you like to see your Teen accomplish at Cteen?  

Briefly describe your teen's personality  

What is your teen's favorite activity?  

Does your teen have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.   

Parent Information
Father's Name  Phone  Email 
Mother's Name  Phone  Email 
Address  City   
State  Zip   
Is child(ren)'s father Jewish*? Yes No  
Is child(ren)'s mother Jewish*? Yes No  

Is the natural mother and maternal grandmother of the teen Jewish? Yes No

 This is the child's primary address

Synagogue Affiliation, if applicable 

General:

I hereby give permission for my child to participate in all CTeen's activities and trips, on and beyond camp properties and allow my teen to be photographed while participating in CTeen activities and that these pictures may be used for marketing purposes.

I also hereby consent to the staff of CTEEN to take any measures they deem necessary for my teen, in the event of a medical emergency.

*Parent/ Guardian  *Date 

 Enter the total amount to be billed today 

1 Session at a time $20 each time ( 10 months) 

Yearly membership $180

 Please enter the Total amount to be billed today $ 

First Name* 

Last Name* 

Address Line 1* 

Address Line 2 

City* 

State* 

Post Code* 

Phone* 
Email*  

**Please Review the Information you entered Above before you click Continue**