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TEEN'S INFORMATION |
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First name |
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Email |
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Last name
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Home Phone |
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Address
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Cell Phone
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City/State
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Facebook Name |
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| Zip Code |
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Date of Birth |
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| High School |
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Graduation Year |
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2 friends I will refer to CTeen (optional):
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What is your preferred method of communication?
Facebook Text Message
Email Any of the above
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| Size (for CTeen T-shirt) |
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Did you join the Cteen Larchmont-Mamaroneck group on Facebook? Yes Not Yet |
| Is your mom or dad Jewish? |
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How did you hear about us? |
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PARENT'S INFORMATION |
| Mother's Name |
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Father's Name |
| Mother's Email |
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Father's Email |
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