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CTeens Registration

CTeens Registration

Cteen Jr Registration

Teen Information
Last Name
First Name
Hebrew Name
Teen email
DOB
School- Fall 2016
Grade Entering
Food allergies? yes no
If yes, please specify:
T-shirt Size

Parent/Emergency Information

Parent's Name
Phone Number
Email Address
Emergency Contact Name:
Emergency Contact Number:
Photo Permission
Photo Permission I understand that my child may be included in photographs and videos that may be filmed during events. I authorize Chabad Jewish Center to use these photos/videos to promote its programs and services in print, web, and other promotional content.
Payment

$180 covers all meetings for the year with a no-turn away policy due to lack of funds.*

Tuiton Plans:

$180 in full upon registration
2 payments of $90 (upon registration and November 1)
4 payments of $45 (upon registration, October 1, November 1, and December 1)
I would like to make other financial arrangements.

*For financial arrangements, please contact Rabbi Mendel at 347-351-6476 or mendelc@jewishlouisiana.com

Method of Payment
CC Type Card Number
Billing Address City, State, Zip
CVV Exp Date

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