Register for CTeen Cares - JewishCarrollCounty.com

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

First Name Last Name
E-mail*
Phone Number*

Area Code Phone Number

Address*

School
Grade entering in September 2022
Birthday

Month Day Year
What is your preferred method of communication?

Facebook Email Text Message All the above
Two friends I would like to refer to CTeen (optional):
Friend 1

First Name Last Name
Friend 2

First Name Last Name
Size for CTeen Tshirt
Is Your Mom or Dad Jewish?

Mom Dad Both
How did you hear about CTeen?
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
Cteen Cares registration $100 (Fees will cover basic expenses for the program such as themed refreshments, supplies, transportation to locations of community service, Cteen T-shirt)

10 SSL HOURS WILL BE EARNED
Total

$0.00

Payment

Credit Card

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Street Address

Street Address Line 2

City

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Teen's Information