CTeen JR Single Event Registration Form

Registration Form
Teen Profile
Has your teen joined a CTeen JR event before?* If yes, We have shortened the application form for your convenience.

YesNo
Family Name*
Name of Teen*
E-mail*
Name Preferred To Be Called*
Teen's Hebrew Name*
Birth Date*

Month Day Year
Grade Entering September 2025*
Gender*

MaleFemale
Teen's Cell Number
Does your teen have any allergies or other medical condition?*
Family Information
Do Both Parents Live In The Same House?*

YesNo

Home Address*

Mother's Address

Father's Address

Father's Cell*
Father's E-mail*
Emergency Information
Emergency Contact *
First Name Last Name
Emergency Contact Phone*
Payment Information
CTeen Junior single event cost: $30

No teen will be turned away due to lack of funds, if you need a discounted rate please contact Mrs. Rochi Silberstein at [email protected]

Payment*

Credit Card Paypal Other

Postal / Zip Code

Country

Total

$0.00
Authorizations
Medical Care Authorization:

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Minneapolis to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Minneapolis personnel will try, but are not required, to communicate with me prior to such treatment.
*

I Accept
Transportation and Photo Authorization:

I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow for my child to be transported to the actvities. I allow my child to be photographed while participating in Chabad Minneapolis activities and that these pictures may be used for marketing purposes.
*

I Accept
Should be Empty:

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Registration Form