Register - Chabad Jewish Center of S. Clemente

Cteen Annual Registration
School Year 2015-16
Membership is required in order to join monthly meetings and events. Annual Fee: $50
Monthly Events will require a small fee for the cost of that event.

Teen's Name		Gender
Hebrew Name		Date of Birth
Last Name		School
Address		Grade
City, Zip & State		Hebrew Birthday
Teen's Cell		Synagogue
Teen's Email		Biological Mother
Emergency Contact		Emergency Contact Phone
Mother's Name		Father's Name
Mother's Phone		Father's Phone
Mother's Email		Father's Email

Payment Method		Card Number
Expiration		CVV Code
Cardholder's Name		Billing Zip
Total Amount		Comments
Check can be mailed to Chabad of S. Clemente • 1306 North El Camino Real • S. Clemente, CA 92672