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Sign Up

Here at CTeen Northridge we have an open-door policy. If you are a Jewish Teen in grades 9-12, we are more than thrilled to have you join in our programs and activities.

Please fill out this form and sign up for CTeen Northridge Membership so we can keep you in the loop of all that we have going on and feel free to send this to anyone you think may be interested.
Teen Name*
First Name Last Name
New or Returning Teen*

New teenReturning teen and filled this form out last yearReturning teen and first time filling out this form
Birth Date*

Month Day Year
Time they were born
Hour Minutes
Hebrew Birthday (if known)
Teen E-mail*
Teen Phone Number*

Area Code Phone Number
School*
Grade*

Address*

Who did you hear about CTeen Northridge from?
Is the natural father of teen Jewish?*

YesNo
Is the natural mother of teen Jewish?*

YesNo
Have there been any conversions in the family?*

YesNo
If yes, please elaborate
Parent 1 Name*
First Name Last Name
Parent 1 E-mail*
Parent 1 Phone Number*

Area Code Phone Number
Parent 2 Name
First Name Last Name
Parent 2 E-mail
Parent 2 Phone Number

Area Code Phone Number
I would like to volunteer as a parent

I am available to carpool to tripsPlease reach out for other parent related volunteer oppurtunities
Help us cover the costs of your teen for all events and programming that happen at CTeen Northridge, and become a committed member of the CTeen Northridge family.

No one will ever be turned away due to lack of funds.
CTeen Membership Program*

Full Membership - $975Subsidized Membership - $540CTeen Northridge Monthly Investor
CTeen Northridge Monthly Investor Sign up for $100 (or more) per month and invest in the future of CTeen Northridge (membership included)

$100$180$360$500$720$1000
Total

$0.00

Payment

Credit Card Contact Rabbi Mendel for other method of payment

Postal / Zip Code

Country

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