Josh Abrams - President
Dylon Del Giglio - Vice President

CTeen Registration Form


Dear Teen,
Thank you for taking the time to complete this application and becoming a member of CTeen of Venetian Islands. You can submit the form via mail, fax (305-397-8938) or below.
To submit by mail/fax please click here to download a printable version.
 

Become a CTeeN Member and enjoy all these benefits:            

  • Covers all events, discounts for larger events
  • Awesome CTeen Gear
  • A membership certificate
  • Discounts at various stores
  • Exclusive events
  • And much more…


Looking forward to an awesome fun-filled year together!
Teen Information
First Name
Last Name
Hebrew Name
Address
City State Zip
  		 Email
Home Phone
Cell Phone
Date of Birth
School
Grade
Best way to contact me
Email Phone
Text Facebook
Parent Information
Father's Name
Father's Cell Father's Email
Mother's Name
Mother's Cell
Mother's Email
Home Phone
Address
 
Payment Information
I will send in a check in the amount of $500
Please charge my credit card in the amount of $500
Amount
Card Type
Card Number
Expiration Month
Expiration Year
CVV Code

Permission is hereby given for Chabad of Venetian Islands CTeen to use in promoting CTeen and in other ventures directly relating to CTeen/Chabad (i) digital, photographic, video, and audio images or likenesses of teen member; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by the teen member or originating from CTeen or from a CTeen related activity.

Signature or Parent/Guardian: Date: