C-Teen 2012/13

jli teen logo.jpg  



Enrollment Agreement

Family Information Form

Family Name    City  
Address   Home Phone  
Zip Code  

Are there any Adoptions/Conversions in the family?

Father's Name   Hebrew if Available  
Address (if different)   City  
Zip Code   Home Phone  
Father's Email   Father's Cell Phone  
Mother's Name   Hebrew if Available  
Address (if different)   City  
Zip Code   Home Phone  
Mother's Email   Mother's Cell Phone  
Marital Status of Parents   Does someone other than the parent(s) care for your child(ren)?  
If yes, please give name   Phone Number  
Teen Information
1. Teen's Name   Hebrew Name  
DOB   Hebrew DOB (if not known, please indicate time of birth)  
Grade Entering   Placement in Family  
Enrollment Agreement
To enroll your child(ren) in the C-Teen program, all forms must be completed and sent in to the school with a $100 non-refundable registration fee per teen (credited towards tuition).  Your application will not be processed without the required forms and fees.  The yearly tuition is $613 per teen, paid by check or cash with the following options:

Full payment due by the beginning of the school year, October 14, 2012.

Special payment plans available upon request only. Please contact us to set up a meeting. 

Checks should be made payable to Chabad Teens, and sent to the Chabad Jewish Center at 26 New Amwell Road in Hillsborough, New Jersey, 08844.  A fee of $25 will be charged for a return check.  Enrollment is considered to be for the entire scholastic year.  There will be no refunds even if the teen is absent due to illness, holidays, vacations and snow days, or should the parents decide to withdraw the teen from the program.
In the event that tuition is not paid,C-Teen reserves the right to debit your Credit/Debit card, plus a $25 processing fee
Card Holder Name Card Type  
Credit Card Number CVV  
Exp Date    Total Paying Now $  
Parent agrees that if payment is not received, C-Teen may terminate the provisions of services.  If C-Teen is terminated under this paragraph, the balance of fees will become due and payable together with interest and 7.5% and legal fees incurred in collecting the amount owed.
If for any reason C-Teen is unable to provide Services at the school for a period in excess of ten business days, C-Teen and/or the Parent may terminate this agreement with written notice.
For off-site trips, parent will be notified in advance and asked to sign permission slips.
Every effort is made to remain open on all regularly scheduled days.  However, if we are forced to be closed or to have a delayed opening, parents will be telephone and/or e-mailed by 8am.  If parent does not answer phone, a message will be left on the answering machine.
By submitting and initialing this form, parents accept the terms outlined above.  
Mother's Initials   Date  
Father's Initials   Date  

 At Chabad there are no membership or building fund fees. We believe every child deserves an amazing Jewish experience. However, we couldn't do it all without the great friends in our community who support our activities.

In lieu of membership fees please consider joining the 'Chai Club'. Your monthly donation (at the amount of your choosing) will make a tangible difference right here in your own community.  

Yes, please count me in for $  per month.