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Cteen Registration
Teen's Name
*
First Name
Last Name
Teen's Email
*
Verify Email
*
Teen's Cell Number
*
School
*
Grade Currently In
*
select one
9th Grade
10th Grade
11th Grade
12th Grade
Any Allergies:
Additional Notable Information
Contact Information
Mother's Full Name
*
First Name
Last Name
Mother's Email
*
Verify Email
*
Mother's Cell Number
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Mother Jewish By
*
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Birth
Choice
Other
Father's Name
First Name
Last Name
Father's Cell Number
Father's Email
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Father Jewish by
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Birth
Choice
Other
Where did you hear about Cteen?
Email
Facebook
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Friend/Colleague
Agreement
*
Feel free to contact Rabbi at rabbi@jewisheugene.org if this is an issue.
I hereby give permission for Chabad of Eugene to photograph my child and to use the images in website, newsletter and flyers.