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B"H

CTeen New Teen Membership Application

Teen Info

Teen's Full Name

Teen's Date of Birth * required

Teen's Mobile Number

School Attending

School Year

Parent or Carer information

Mother's name

Mother's Mobile Number

Mother's email address

Father's name

Father's Mobile Number

Father's Email address

Mother's home address

Father's home address (leave blank if it's the same address as Mother's)

Emergency Alternative Contact Name

Relationship of emergency alternative contact to Teen

Phone Number of Emergency Alternative Contact

Jewish Verification

Membership of CTeen is open to all teens recognised as Halachicly Jewish as defined by the Office of the Chief Rabbi.

Is Mother Jewsih? *

Yes by birth

Yes by Orthodox Halachic Conversion in accordance with and recognised by the Office of the Chief Rabbi

Please upload documents to verify this

Upload File

Upload supported file (Max 15MB)

Please write the name and contact number of a Rabbi as a reference - This needs to be a Rabbi other than Rabbi Sholom Cohen:

Is Father Jewish?

Yes

Health Information

Do you have any allergies? *

Yes

Please write any medical conditions, medications we need to know about, relevant Physical or Mental Health Concerns (leave blank if not relevant)

Permissions and Consent

I grant permission for CTeen to take photographs and videos of my teen and use for promotional purposes *

Yes

In case of a medical emergency, I authorize CTeen staff to obtain necessary medical treatment for my Teen *

Yes

I grant CTeen permission to contact school or external agencies if relevant to member's well-being *

Yes

I grant permission for CTeen to collect and store personal data in accordance with GDPR *

Yes

Parent/Carer's Signature

Date of Signature * required

CTeen lounge: Park Lane, Salford
M7 4JD
Manchester, England, M7 4JD

Contact Us

Email: office@cteenmanchester.co.uk

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