CTeen Membership Form
Thank you for taking the time to complete this application and becoming a member of CTeen of Hallandale. Membership is $195 for the year.
Membership includes:
- Personal login app for volunteer hours
- End of year letters for hours
- Recommendation letter at end of the year
- End of the year community gala dinner comp invite (must fulfill the quota)
- New York Shabbaton registration discount (10% off regular price)
- Points towards Silver, Gold, Platinum Teen Status
Teen's Information:
First Name
Last Name
Hebrew Name
Date of Birth
Home Address
Home Phone Cell
Email
School Grade
Best way to contact me is email phonetext facebook
Leader who referred me
Parent's Information:
Father's Name cell
Mother's Name cell
Email
Home phone
Home Address
Payment Info:
Name on Card:
Card Number
Expiration (mmyy)
Permission is hereby given for Chabad of Hallandale/SouthBroward to use in promoting CTeen and in other ventures directly relating to CTeen/Chabad (i) digital, photographic, video, and audio images or likenesses of teen member; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by the teen member or originating from CTeen or from a CTeen related activity.
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