ב"ה

CTeen Jr Shabbaton

This form is currently closed.

Child's Name*
First Name Last Name
I hereby authorize my child to go on the Cteen Jr shabbaton, in Upstate NY, April 24 through April 25, 2026 with Toba KIevman and Shaina Hecht*
First Name Last Name
Parent Phone Number*
Please provide information regarding any medical needs, food concerns, or anything else we should know to best support your child
In case of an emergency, we will try and reach you on the phone numbers you provided. If we can't successfully reach you, please list another authorized person that we should contact*
First Name Last Name
Additional Emergency Contact Phone Number*
In case of an emergency I hereby authorize Chabad's certified staff, or the local hospital, to provide any first aid or emergency care deemed necessary for my child.*
First Name Last Name
To help cover the expenses of the Shabbaton weekend, there is charge of $150 per teen. The actual cost per child is $275.

We understand that each family has different financial abilities and we therefore leave it to your discretion.
Payment*

150200275
Please consider helping to sponsor another teen

$36$72$108$180$275
Total

$0.00

Payment*

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

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