Register - Chabad of the Venetian & Sunset Islands

CTeen Jr. meets Sunday, 10:00 am - 12:30 pm,
boys and girls grades 7 and 8.
Teen Profile
Teen's Name*
First NameLast NameHebrew Name
E-mail*
Cell Phone*
Area CodePhone Number
Age*
Birth Date*
MonthDayYear
at HourMinutes
School Attending*
Grade*

Address*

Additional notable Information
Parents Information
Father's Name*
First NameLast Name
Father Cell
Area CodePhone Number
Father's E-mail*
Mother's Name*
First NameLast Name
Mother's Hebrew Name*
Mother Cell
Area CodePhone Number
Mother's E-mail*
Is the natural mother of the child Jewish?*
YesNo
Were there any conversions or adoptions in your family? If Yes, Please describe.*
Emergency Contact Name*
Emergency Contact Number*
Area CodePhone Number
Please list any allergies or health concerns*
My hobbies, talents or interests
Payment
Cost*
$770 per teen (includes supplies/book fee)
Installments
Payment in full upon submissionTwo installments to be paid on Sept. 1 and Jan. 2
Total
$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

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Teen Profile