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Programs Youth Programs

C-Teen Jr. Sign Up

Join the C-Teen regional and explore the next level up!
What we will be doing: Canoeing and chill by a BBQ!
Date: Sunday April 25th
Time: 4:30 - 6:45 PM
Location: Wilson Landing Park, 379 Malekean Trail, Sanford FL 32732
C-Teen Jr. Registration!
How many teens are coming?*
Teen#1 Full Name:*
First NameLast Name
Teen#2 Full Name:*
First NameLast Name
Teen#1 Cell Phone:*
Area CodePhone Number
Teen#2 Cell Phone:*
Area CodePhone Number

Teen#1 Address:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Teen#2 Address:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Teen#1 Birth Date:*
MonthDayYear
Teen#2 Birth Date:*
MonthDayYear
Teen#1 School:*
Teen#2 School:*
Teen#1 Grade:*
Teen#2 Grade:*
Please help out!
Yes! I love that my child has a social event geared for him/her:$180Yes! I love that my child has a social event geared for him/her:$360
Total:
$0.00

Payment:

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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