ב"ה

Join

I AM A TEEN (this registration is for me) MY TEEN (I am a parent, this registration is for my teen)
Teen's Information
Full Name*

First Name Last Name
E-mail*
Phone Number

Area Code Phone Number

Address

High School
Graduation Year
Birthday

Month Day Year
What is your preferred method of communication?

FB Email Text Message All of the above
Two friends I would like to refer to CTeen (optional):
Friend 1
Friend 2
Size for cTeen tshirt:
Is your mom or dad Jewish?

Mom Dad Both
Parent's Information
Mother's Name

First Name Last Name
Mother's E-mail
Mother's Phone Number

Area Code Phone Number
Father's Name

First Name Last Name
Father's E-mail
Father's Phone Number

Area Code Phone Number
$180 Membership - club membership includes cool gear, monthly club meetups, learning program, supplies, humanitarian projects, dinners and 20% off regional trips.
Registration*

$180
I would like to make a donation to sponsor another teen:

$
Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

100% of the proceeds of this donation or payment benefit the Jewish Discovery Center.
Should be Empty:

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