CTeen Online Membership for 2018-19


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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