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
2 digit day, 2 digit month, 4 digit yearDate
Current Age
Gender
My Jewish Background
Teen's Phone Number
Format: (000) 000-0000.
Teens email
example@example.com
Address
T-shirt Size

Other
Please upload image of your Passport / Traveling ID

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Do you have a student ID? If yes please upload

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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
2 digit month, 2 digit day, 4 digit yearDate
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
2 digit month, 2 digit day, 4 digit yearDate
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

Other - 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

11,000.00 INR

Cteen One day Fun Day

May 6

950.00 INR

Cteen Mumbai Summit

May 25 - 26

1,850.00 INR

Enter coupon

Total

Should be Empty:

2026 CTeen Camp Registration Form

Choose the Camp Dates you would like to join.

Payment*

Payment