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CTeen Registration
1. Teen Information
Name*
First NameMiddle NameLast Name
Birth Date*
MonthDayYear
E-mail*
Cell Phone Number*
Area CodePhone Number
Grade*
Do you grant CTeen permission to use photographs of your teen in its publications and social media, relating to the mission of CTeen Silicon Valley and its promotion?*
YesNo
If this is your first time joining Cteen how did you hear about this program?
2. Parent Information
Parent*
First NameLast Name
Cell phone number*
Area CodePhone Number
Parent E-mail*

Home address*

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CTeen Registration