of Skokie

Cteen Jr. Registration 2018/19

Cteen Jr. Registration
Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
Grade for 2018-2019*
6th Grade7th Grade8th Grade
School attending for 2018-2019 year*
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Mother's Name:*
First NameLast Name
Mother's Cell:*
Area CodePhone Number
Home Phone:*
Area CodePhone Number
Father's Name:*
First NameLast Name
Father's Cell:*
Area CodePhone Number

Address:*

Mother's E-mail:*
Father's E-mail:*
Payment
-- Cteen Jewish Essentials are $20/meeting (drop-in price) or $350 for the full year.
-- Cteen Jr. Socials are $15/meeting (drop-in price) or $75 for all 6 meetings.
-- Sign up for all Cteen Jr. Social & Jewish Essentials for $400 total.
I am paying for:*
All 2018/19 sessions: 21 Jewish Essentials meetings, and 6 Cteen Jr. SocialsAll Jewish Essentials meetingsA single Jewish Essentials meeting (please specify date in comments below)All Cteen Jr. Social eventsSlime Factory - 10/16/18Masterchef - 11/27/18Woodworks - 2/5/19Magnetic! - 3/5/19Looking Sharp - 4/2/19Color Party - 5/7/19
Total
$0.00
Comments:

Payment*

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Skokie Cteen 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, Skokie Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities. I allow my child to be photographed while participating in Skokie Cteen activities and acknowledge that these pictures may be used for marketing purposes.
*
I Accept
Initials*
Should be Empty:

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Cteen Jr. Registration