CTeen Jr Registration

Register for Cteen Jr.
Sundays 11:30 AM – 1:30 PM
We are currently accepting CTeen Jr. applications for the 2022-23 school year. Please fill out ALL fields of this form. You can register and make your payment online, or mail your check: Please print this form and include it with your check payable to: The Shul of Bellaire. If you have any questions or concerns you'd like to discuss, please contact us.
Please note that one registration form per child is required.
We look forward to a wonderful year of learning and growth!
TEEN INFORMATION
Full Name*
First NameLast Name
Hebrew Name
Grade Entering*
Birth Date*
MonthDayYear
Exact Time of Birth*
City of Birth*
Knowledge of Basic Judaism
NoneSomewhatWell
Hebrew Reading
Does not read HebrewRecognizes the Aleph-BetReads Hebrew slowlyReads Hebrew well
PARENT INFORMATION
Father's Name*
Father's Cell
E-mail
Mother's Name*
Mother's Cell
E-mail
Home Phone Number
Area CodePhone Number

Address*

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

Were there any conversions or adoptions in the family?*
YesNo
Please explain:
GETTING TO KNOW YOU
Please answer the following questions to help us know about your family and teen:
If your child had a Hebrew School/day school education, please describe their experience:
Is there any other information you would like to share about your family?
How would you describe your teen?
Does your teen have any particular hobbies or passions?
Does your teen had any behavioral or developmental difficulties or challenges in his/her regular school day?
Is there any other information you would like to share/ have us know about your teen?
EMERGENCY INFORMATION
Emergency Contact 1
First NameLast Name
Phone Number
Area CodePhone Number
Emergency Contact 2
First NameLast Name
Phone Number
Area CodePhone Number
CONFIDENTIAL: Does your teen have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
I accept:*
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of 'The Shul of Bellaire' 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, 'The Shul of Bellaire' 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 school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in 'Hebrew School' activities and that these pictures may be used for marketing purposes.
Name*
Initials*
PAYMENT OPTIONS
Cteen Jr. membership for the 2022/23 school year is $945.00 per teen.
Monthly credit-card payment plan or post-dated checks are accepted and must be submitted before the first day of Hebrew School. Thank you!
Please select:*
Payment in full.3 payments of $315
Total
$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

We look forward to a wonderful year of learning and growth!
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TEEN INFORMATION

PARENT INFORMATION

GETTING TO KNOW YOU

EMERGENCY INFORMATION

PAYMENT OPTIONS