Printed fromchabadaac.com

of Anne Arundel County

ב"ה

Registration

Please select:*
I AM A TEEN (this registration is for me)MY TEEN (I am a parent, this registration is for my teen)
Teen's Information
Full Name*
First NameLast Name
E-mail*
Phone Number*
Area CodePhone Number

Address*

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

School*
Grade entered in September 2021**
Birth Date*
MonthDayYear
What is your preferred method of communication?*
EmailText MessageBoth
Two friends I would like to refer to CTeen (optional):
Friend 1:
First NameLast Name
Friend 2:
First NameLast Name
Is Your Mom or Dad Jewish?*
MomDadBoth
How did you hear about CTeen?
Parent's Information
Mother's Full Name*
First NameLast Name
E-mail*
Phone Number*
Area CodePhone Number
Cteen Cares registration $100 (Fees will cover basic expenses for the program such as refreshments, supplies, and discount for the annual Cteen NY Shabbaton and regional trips)
Yes, I look forward to a great year as a CTeen Member:*
CTeen Membership $100I'd like to donate towards CTeen's wonderful projects
Please accept my donation of:
$
Total
$0.00

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.

Community Service (SSL Eligible)

Foster Jewish Pride and Friendships

Thought Provoking Conversations