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Cteen HS Membership

CTeen HS Membership 2025-26
Your Teen Membership gives you:
- Stay in the loop of our teen program and events
- Discounted registration for events
- Early Access and discount to the International Shabbaton Weekend
- Have a voice in the local teen community
- Access to Community Service Volunteer Hours
- Access to private study or conversation with Rabbi Menashe and Leah
* Membership is not required to join in or attend any of our teen events.
TEEN:
Full Name*
First Name Last Name
Hebrew Name*
Date of Birth*

Month Day Year
Time of Birth*
School Name*
Grade*
Cell Number *
E-mail
Instagram

Address*

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

Allergies
Notable Information
PARENTS:
Parent #1
Full Name*
First Name Last Name
Gender *
Mobile*

Area Code Phone Number
E-mail*
Address*

Same as ChildOther

Parent #1 Address*

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

Were there conversions or adoptions in the family?*

YesNo
Parent #2
Parent #2 Full Name*
First Name Last Name
Gender*
Phone Number*

Area Code Phone Number
E-mail
Address

Same as childOther

Address of Parent #2

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

Were there conversions or adoptions in the family

YesNo
Parents' Information
Marital Status*

MarriedSeparatedDivorcedSingleDeceased
I give my child permission to participate in all CTeen Events, trips, and programs*

YesNo
I give permission for CTeen staff to contact my child directly*

YesNo
Preferred contact method*

Child and Parent #1Child and Parent #2Child and both ParentsOnly Parents
I would like to join a parent WhatsApp chat*

YesNo
FEE
Introductory Membership*

$18
Partner with us in building a vibrant Jewish teen community or sponsor another child’s membership
Optional Donation

$54$108$360$500$1000
Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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