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CTeen Jr RSVP

Full Name*
First Name Last Name
Gender:*

MaleFemale
E-mail*
Allergies
If this is your first time RSVPing for a CTeen Conejo event - Please visit www.chaiconejo.com/cteenwaiver to fill out the CTeen Conejo Permissions/Liability Waiver Waiver Form. This form only needs to be filled out once per participant. If you have filled this out already select "yes" below.
I have signed and submitted the CTeen Conejo Permissions/ Liability Waiver Form:*

Yes
Enroll for Full Year?

Yes, enroll for Full Year - $749No, I would like to sign up by session.
I am also registering for a sibling
Sibling Info:
Sibling's Name
First Name Last Name
Gender:

MaleFemale
E-mail
Allergies
If this is your first time RSVPing for a CTeen Conejo event - Please visit www.chaiconejo.com/cteenwaiver (in a different window) to fill out the CTeen Conejo Permissions/Liability Waiver Form. This form only needs to be filled out once per participant. If you have filled this out already select "yes" below.
I have signed and submitted the CTeen Conejo Permissions/ Liability Form:

Yes
Enroll for Full Year?

Yes, enroll for Full Year - $749No, I would like to sign up by session:
Girl's Schedule:

Girls Session 5: Apr 27, May 4, 18, 25 - $119
Boy's Schedule:

Boys Session 5: Apr 24, May 1, 8, 15, 22, 29 - $149
Parent's Info
Parent's Name*
First Name Last Name
Phone Number*
E-mail*
Total

$0.00
Payment Method*

Credit CardCash/Check

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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