JTeen Club Registration Form 2022-2023-5783

* Are you a new JTeen Club member or a returning member?

* Teen First Name

* Teen Last Name

Teen Jewish Name

Please Select OneMaleFemale

* Date Of Birth

* Grade Entering Sept. 2022

* Day School

* Cell Phone Number

* Email Address

* Street Address

* City

* State

* Zip Code

Home Phone

* How did you hear about us?

Marital Status of Parents

Teen lives with

* Father's Full Name

Father's Jewish Name

* Jewish Status

Please Select OneJewishNot Jewish

Father's Cell

Father's Email

* Mother's Full Name

* Jewish Status

Please Select OneJewishNot Jewish

Mother's Jewish Name

Mother's Cell

Mother's Email

* Emergency Contact Name

* Relationship to Teen

* Phone 1

Phone 2

JTEEN CLUB AGREEMENT

I agree that my/our child/ren be in photos & video and allow these to be published in any form.

In order to ensure complete safety during meetings, members of the teen club must remain within the Center for Jewish Life at all times, unless instructed otherwise by an authorized JTeen leader/coordinator.
A pleasant atmosphere and proper decorum is integral at all JTeen meetings and events, and thus, any conduct or language that expresses disrespect for others will not be tolerated.
Cell phone usage will not be allowed during meetings (only during breaks). A member who uses his/her cell phone during meetings will be asked to leave the meeting and arrange a ride home.
Parents are responsible to pick up their child at 8:30 pm prompt and take full responsibility after this time.

Medical Release

In case of an emergency, I request that Center for Jewish Life contact me. If I am not within reach I request that the Emergency Contact listed on this form be contacted. I hereby consent to the administration of Center for Jewish Life to take whatever medical measures they deem necessary for my child in the event of a medical emergency.

* I have read and accepted all terms and conditions set forth on this application.

I have read and accepted all terms and conditions set forth on this application.

* Parent/Guardian Signature

* Teen Signature

There is no fee for the JTeen Club. All teens attending are required to purchase a JTeen Club t-shirt for $25. Please select your shirt size below.

* T-Shirt Size

Total

Connect With CJL

Center for Jewish Life • 176 Route 79 North Marlboro, NJ 07746 • Phone: 732-316-7600 • Fax: 732-316-0300 • info@cjlnj.com