Cteen Registration

  • Part 1: Teen Info

  • Part 2: Parent Information

  • Part 3: Medical Information

  • Person to be contacted in case of an emergency when parents cannot be reached.

  • In case of an emergency, I (we) authorize Chabad of Old Tappan to take whatever medical measures they deem necessary for my child in the event of a medical emergency.

  • Part 4: Agreements and Membership Fee

  • Annual membership fee of $150 is optional. Membership fee does not include fees associated with social trips and transportation.

  • $0.00
    Credit Card
    Checks should be made out to:
    Chabad of Old Tappan
    183 Old Tappan Road, Suite 6
    Old Tappan, NJ 07675
    Billing Address
  • Should be Empty:
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