Printed from ChabadofKendall.org

Of Miami-Kendall/Pinecrest

CTEEN REGISTRATION

CTEEN meets typically on Thursdays from 6:15-7:45 at the Chabad of Kendall/ Pinecrest.
First Meeting: September 6th, 2018
CTEEN Jr meets typically on Tuesdays from 6:00-7:30 p.m. at the Chabad of Kendall/Pinecrest.
First Meeting: September 4th, 2018
Program
CTEENCTEEN JR
Teen Information
Full Name
First NameLast Name
Hebrew Name
Grade
School
Birth Date
MonthDayYear
E-mail
Cell Phone
Area CodePhone Number

Address

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

Parent Information
Full Name - Mother
First NameLast Name
Mother's Email
Mother's Cell
Area CodePhone Number
Full Name - Father
First NameLast Name
Father's Email
Fathers Cell
Area CodePhone Number
Other Information
Are the natural parents of child Jewish?
FatherMotherBoth
Were there any conversions or adoptions in your family?
MotherFatherMaternal GrandmotherPaternal Grandmother
Please explain:
Currently attending other Youth Groups
YesNo
if yes, which?
Payment
Fee
$180

Payment

Credit Card Payment Plan

Postal / Zip Code

Country

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CTEEN Miami

cteen@chabadofkendall.org