CTEEN Registration - Register now - Chabad Lubavitch of Idaho

Number of teens*

Name*

Child First Name Child Last Name

Hebrew & Nickname*

First Name Nickname

Gender*

MaleFemale

Birth Date*

Month Day Year

Teen Phone Number

Area Code Phone Number

Teen Email* If no email, please use parent's email

School*

Grade*

Previous Jewish Education*

Chabad Hebrew SchoolCTEEN JRNone

Yes, I want to register for CTEEN*

CTEEN

Name 2*

Child First Name Child Last Name

Hebrew & Nickname 2*

First Name Nickname

Gender 2*

MaleFemale

Birth Date 2*

Month Day Year

Teen 2 Phone Number

Area Code Phone Number

Teen 2 Email* If no email, please use parent's email

School 2*

Grade 2*

Previous Jewish Education 2*

Chabad Hebrew SchoolCTEEN JRNone

Yes, I want to register for CTEEN*

CTEEN

Address*

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

Home Phone Number*

Area Code Phone Number

Parent/Guardian Marital Status*

Parent 1 (or Guardian) Name*

First Name Last Name

Parent 1 Type*

Parent 1 Occupation*

Parent 1 Business Phone*

Area Code Phone Number

Parent 1 E-mail*

Parent 1 Cell Phone*

Area Code Phone Number

Parent 2 (or Guardian) Name*

First Name Last Name

Parent 2 Address*

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

Parent 2 Home Phone Number*

Area Code Phone Number

Parent 2 Type*

Parent 2 Occupation*

Parent 2 Business Phone*

Area Code Phone Number

Parent 2 E-mail*

Parent 2 Cell Phone*

Area Code Phone Number

Father's Religion*

Mother's Religion*

Is child adopted or born through surrogacy*

NoYes

Synagogue Affiliation*

Were there any conversions or adoptions in the family (including parents and grandparents)?*

NoYes

1. Child/ren may be picked up by:

Name and Relationship

2. Child/ren may be picked up by:

Name and Relationship

Emergency Contact Name*

First Name Last Name

Phone Number*

Area Code Phone Number

Address*

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

Relationship*

Family Physician*

First Name Last Name

Phone Number*

Area Code Phone Number

Medical Insurance Company*

Insurance Group Number

Primary Insured Policy Number*

Teen Policy Number*

Teen 2 Policy Number*

MEDICAL RELEASE

I hereby give consent to the administration of CTEEN and Chabad Lubavitch of Idaho to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. I understand that, when possible, every effort will be made to contact parent/guardian or emergency contact before CTEEN/Chabad Lubavitch of Idaho will undertake such decision.

COVID-19 AGREEMENT* At the moment, we do not anticipate any COVID-19 restrictions or protocols.

I will follow any and all current and potential health & safety protocols regarding Covid-19 and affirm that I assume all risk and will not hold Chabad Lubavitch of Idaho or CTEEN or its staff, volunteers and attendees liable if exposed to Covid-19.

Signature of Parent or Guardian*

Date & Time*

Month Day Year

at Hour Minutes

My teen/s is permitted to be given Children's Tylenol, Motrin or similar:*

YesNo

Is your teen/s allergic to any medications?*

NoYes

Please specify medical allergies.

Is your teen/s allergic to any foods?*

NoYes

Please specify food allergies.

Is your teen/s up to date on all immunizations?*

YesNo

Does your teen/s have a medical, developmental or emotional condition that camp should be aware of?*

YesNo

Please specify condition(s).*

I hereby permit my child to participate in all school activities, and to join in class and school trips on and beyond school properties and use any transportation selected by the CTEEN.

Permission is hereby given to use in promoting the school and in other ventures directly relating to the school (i) digital, photographic and video images or likenesses of student; audio of student; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by student or originating from CTEEN or from a school-related activity.

I further release and agree to indemnify and hold harmless Chabad Lubavitch of Idaho, Chabad Jewish Center, CTEEN and its officers, servants or assigns from any liability concerning my child’s involvement in CTEEN and further agree that the use of any premises during the CTEEN day is made at the risk of the registrant.

I understand and agree that CTEEN reserves the right to dismiss, in its sole discretion, any student whose condition, conduct, influence or behavior is deemed unsatisfactory or detrimental to the best interests of CTEEN or fellow students or who violates CTEEN rules and regulations. In the event of dismissal, fees paid will be forfeited.

I have read and agree to all of the terms and conditions in this Application Form. I am including a non-refundable $50.00 registration fee per student along with submission of this form.

Signature of Parent or Guardian*

Date & Time*

Month Day Year

at Hour Minutes

Comments:

Payment is a $100.00 non-refundable fee.

If you need a scholarship, please contact us.

Please Note: CTEEN membership is not a monthly or session-based fee, but a one-time charge per semester. Chabad does not refund payment for sessions missed.

Your card will be charged a non-refundable $100 registration fee per student.

Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

(978) 972-1684

mushka@jewishidaho.com

Boise, ID, 83709

Register

Register now

CTEEN Registration 2025-2026 Second Semester

MEDICAL AND EMERGENCY CONTACT INFORMATION

Parental Consent

COMMENTS

FINANCIAL ARRANGEMENTS

PAYMENT

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