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Youth Programs Teens

CTeen Registration

This form is currently closed.

Chabad TMR CTeen Registration form
All programs run from 5:30-7:00 pm at Chabad TMR unless notified otherwise.
Full Name*
First Name Last Name
Birth Date*

Month Day Year
Jewish Birthday
If known
School
Grade

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone

Area Code Phone Number
Cell Phone

Area Code Phone Number
E-mail*
Facebook
Father's Name
First Name Last Name
Father's Phone

Area Code Phone Number
Father's E-mail
Mother's Name
First Name Last Name
Mother's Phone

Area Code Phone Number
Mother's E-mail
Session Charge*

$80 CAD
Comments/Questions

Payment*

Credit Card Paypal E-Transfer to [email protected]

Postal / Zip Code

Country

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