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.

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