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2021 Twelve & Thirteen Enrolment Form
If you have any questions about the program, please head to
www.twelvethirteen.org/faqs
. If you require assistance please contact us at
hello@twelvethirteen.org
.
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* Indicates required question
Please confirm you would like to enrol in:
*
2021 Twelve & Thirteen Program
Full Name of Adolescent
*
Your answer
Please indicate your teen's gender.
*
Choose
Female
Male
Non Binary
Full name of Parent/Guardian 1
*
Your answer
Parent/Guardian 1 Email Address
*
Your answer
Parent/Guardian 1 Mobile phone number
*
Your answer
Please list any allergies your Young Adult has (or state none)
*
Your answer
Please list any medical conditions your young adult has (or state none)
*
Your answer
Do you give permission for us to use photographs of your young adult/family for marketing and social media purposes?
*
Yes
No
Full name of Parent/Guardian 2
Your answer
Parent/Guardian 2 Email Address
Your answer
Parent/Guardian 2 Mobile phone number
Your answer
Parent/Guardian 1 Residential Address
*
Your answer
Young Adult's School in 2021
*
Your answer
Young Adult's Year Level in 2021
*
Your answer
Young Adult's Date of Birth
*
Your answer
Young Adult's Phone Number
Required for Learning Labs and WhatsApp activations, can use Parent's
Your answer
Young Adult's Email Address
Required for Learning Labs and WhatsApp activations, can use Parent's
Your answer
Is your adolescent participating in any other Bar/Batmitzvah program? If yes, please list.
*
Your answer
How did you hear about Twelve & Thirteen?
*
Word of Mouth
Social Media
Advertising
Previous participant
Other:
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