Teen Club Registration

Now registering for 2021-2022!
For any questions or comments you can contact us at: [email protected] / (201) 886-1238
Teen Information
Teen 1
How many Teens are you signing up today?*
Maximum 2 siblings per form
Teens Full Name*
First NameLast Name
Date of Birth*
MonthDayYear
Teens E-mail*
Teens Cell Phone*
Area CodePhone Number
Grade entering September 2021*
Second sibling (Teen 2)
Sibling Full Name
First NameLast Name
Date of Birth
MonthDayYear
Sibling E-mail
Sibling Cell Phone
Area CodePhone Number
Grade entering September 2021
Parents Information
Parent 1
Full name*
First NameLast Name
Cell Phone*
Area CodePhone Number
E-mail*
Parent 2 (If applicable)
Full Name
First NameLast Name
Cell Phone
Area CodePhone Number
E-mail
Home information

Address*

Is your child's natural mother and maternal grandmother Jewish?*
YesNo
Have there been any conversions or adoptions in the family?*
YesNo
Please help us keep Teen Club FREE! with a donation of any amount! :)
I would like to support Teen Club with a Donation of:$360 = 1 Week of Teen Club (You can sponsor the week of your child's Birthday)
$100.00$180.00$360.00$540.00
Total
$0.00

Payment

Credit Card Other

Postal / Zip Code

Country

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