Monday Evenings, 7:00-8:30 PM Teen's Name:* First Name Last Name Date of Birth:* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Teen's Phone Number Area Code Phone Number (Teen's) Teen's E-mail:* Teen's School:* Teen's Grade:* Parent's Names: First Name Last Name Parent's Phone Number: Area Code Phone Number (Parent's) Parent's E-mail: Emergency Contact Primary Emergency Contact Name:* First Name Last Name Phone Number:* Area Code Phone Number Relationship to Child:* Secondary Emergency Contact Name: First Name Last Name Phone Number: Area Code Phone Number Relationship to Child: Medical Information Hospital/Clinic Preference:* Physician’s Name:* First Name Last Name Physician’s Phone Number:* Area Code Phone Number Insurance Company: Policy Number: Allergies/Special Health Considerations: Authorization:* I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.I give permission for my child to go on field trips. I release Aventura Chabad and individuals from liability in case of accident during activities related to Aventura Chabad, as long as normal safety procedures have been taken.By entering your first and last name below, you electronically acknowledge having read and understood this Agreement and agree to the terms and conditions herein.Your first and last name below represents your agreement to all the terms and conditions written above and will serve as your consent to all the terms and conditions written above. Signature:* First Name Last Name Date:* Additional Notes / Information New York ShabbatonDates: Feb 19-22, 2026 There is an optional trip to NYC for an additional fee where around 4,000 teens from all around the world meet and participate in a weekend Shabbaton (Thursday - Sunday). For more information visit: https://shabbaton.cteen.com/ You can add the trip now for an additional $950 which will be added to your total and reflected in your payment plan. The cost includes airfare, housing, meals, and activities. (The trip is only offered to registered C-Teen participants) Note: You can decide to add the trip later, but the price will go up with time. Trip Deadlines and Costs: Early Bird until Nov 16: $950 Regular Price until Dec 19: $1,100 Late Registration until Jan 11: $1,250 Financial Aid Application: due by November 10, 2025 *Financial Aid will be granted based on need and availability. If you are certain that you want your teen to attend the Shabbaton, but have financial needs, please contact [email protected] for information on scholarship applications. Cteen Prices:  (Excluding trips) (9th-12th Grade) NY Trip: $950 Leaders: $200 Discount Cteen Junior Prices: (7th-8th Grade)  $550 - Non-Members $500 - Members  $550 - Non- Members $500 - Members Pre-Registration by May 15: $50 Discount Have you been chosen by the Director as a Leader?* YesNo Current member?* YesNo Teen Division:* Cteen (9th - 12th Grade)Cteen Jr (7th - 8th Grade) Teen Division:* Cteen (9th - 12th Grade)Cteen Jr (7th - 8th Grade) Are you a current member? YesNo Include NYC Shabbaton:* YesNo Total Amount: $0.00 Please note that a 3.5% charge will be added to Credit Card payments. If you wish to pay with a different method, please continue with the registration as payment is charged manually, and contact the office at 305-933-0770 to discuss other payment options. Payment:* ⚠You have not yet connected a credit card processor.Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Payment Options: Full Payment2 Payments3 Payments6 Payments Terms of Agreement(PLEASE READ CAREFULLY-NO EXCEPTIONS) I understand:* 1. Payment in full is due with application, including all head checks or credit cards.2. Payment is Non-Refundable, for any reason, even if your child does not attend the program.3. Withdrawal of enrollment privileges, for any reason, does not relieve the Undersigned of the responsibility for the payment of the entire financial obligations for the program you enrolled your child in.4. By entering your first and last name below, you electronically acknowledge having read and understood this Agreement and agree to the terms and conditions herein.5. Your first and last name below represents your agreement to all the terms and conditions written above and will serve as your consent to all of the terms and conditions written above. Signature:* First Name Last Name Date:* Submit  Print Form Should be Empty: This page uses TLS encryption to keep your data secure.