Clone of 2025 Cteen Extreme Camp 5785

2026 CTeen Camp Registration Form

Please fill out the following form accurately and completely. This information will help us ensure a safe and enjoyable week for all participants.
Teen information:
Name*

First NameMiddle NameLast Name
Teen's Date of Birth*

DayMonthYear
Date
Current Age*
Gender*
My Jewish Background*
Teen's Phone Number*
Format: (000) 000-0000.
Teens email*
example@example.com
Address*
T-shirt Size*

Extra SmallSmallMediumLargeExtra LargeXX LargeXXX LargeOther
Please upload image of your Passport / Traveling ID*

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Do you have a student ID? If yes please upload

Cancelof
Do you have a student ID? If yes please upload
Family Information
Mother’s Full name*
Mother’s Contact number*
Please enter a valid phone number.Format: (000) 000-0000.
Mother’s Birthday*

MonthDayYear
Date
Mother’s surname before marriage*
Mother’s Email address*
example@example.com
Father's Full name*
Father's Contact number*
Please enter a valid phone number.Format: (000) 000-0000.
Father's Birthday*

MonthDayYear
Date
Father's Email address*
example@example.com
Number to be added to Camp Whatsapp group:*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency contact*

FatherMotherOther - Name, Contact, Connection to teen.
Any important information we should know about the family?
Medical Information:
Allergies (if any):
Current Medications (if any):
Chronic Illnesses/Conditions (if any):
Dietary Restrictions:
Any Recent Injuries/Surgeries:
Blood Type (if known):
Any important information we should know about the teens Emotional, Social or Physical health?
Signature (Teen):*
[Parent/Guardian's Name]*
Signature (Parent/Guardian):*
Choose the Camp Dates you would like to join.

18% Earlybird Discount until March 30!

Payment*

Cteen Camp Bangalore Bound

May 13 - May 18

11,000.00INR

Cteen One day Fun Day

May 6

950.00INR

Cteen Mumbai Summit

May 25 - 26

1,850.00INR

Enter coupon

Total

0.00INR

Should be Empty:

2026 CTeen Camp Registration Form

Choose the Camp Dates you would like to join.