Register - CTeen Jr. - Hebrew School

Register - CTeen Jr. - Hebrew School
Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, feel free to call our director Sara Bluming at 240-621-0770 or email [email protected].
Teen Profile
Student Name
First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Time of Birth In Judaism the day begins at nightfall, so in order to determine the exact date of your Jewish birthday we need to know what time of day you were born.
School
Entering Grade
Parent Information

Address

Father's Name
First Name Last Name
Father's Occupation
Father's Cell
Father's Email*
Mother's Name
First Name Last Name
Mother's Occupation
Mother's Cell
Mother's Email*
Maternal grandmother born Jewish?*

YesNo
Mother born Jewish?*

YesNo
Converted by whom? Name of Rabbi & Beit Din*
Upload conversion documentation*
Any adoptions in the family?

YesNo
In relation to any adoptions, please explain
Emergency Information
Emergency Contact 1
First Name Last Name
Cell number
Emergency Contact 2
First Name Last Name
Cell number
Doctor's Name
Doctor's phone number
Medical Insurance Company
Policy Number
Confidential Does your child have any allergies or other medical condition we should be aware of> If yes, please describe them and indicate special precautions or care needed.
Registration Payment Agreement

This registration form is for payment of registration fees only(Registration: $50/child early bird by June 1; $100/child after June 1). Payment for CTeen Jr tuition is by check or cash. If you choose to pay by credit card, please use the "Tuition Payment page" which automatically adds the 3.5% credit card fee which we incur. Tuition payment is due in full by September 1, 2026 or half by September 1, 2026 and half by January 15, 2027.

Tuition for the year, per child: $1200 (includes security fee and books)
Discount: 10% for each additional child.
Early Bird Registration*
Registration*
Total

$0.00

Payment

Credit Card Paypal Check

Postal / Zip Code

Country

Date

Month Day Year
at Hour Minutes
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of CTeen Jr. to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, CTeen Jr. personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all activities, join in trips on and beyond school properties and allow my child to be photographed while participating in CTeen Jr. activities and that these pictures may be used for marketing purposes.
Agreement

I Accept
I grant my child permission to join all Cteen Jr. trips and transportation to trips.
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Your children deserve nothing but the best. Give them the gift of a Jewish education that will remain with them forever. Call 240-621-0770

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