CTeen registration form
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February 23 Game Night *
Required
Teen information
First Name *
Last Name *
School *
Grade *
Date of birth *
MM
/
DD
/
YYYY
E-mail *
Cell phone *
Address *
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.
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Mother's information
Mother's first name *
Mother's last name *
Mother's e-mail *
Mother's cell phone *
Father's information
Father's first name
Father's last name
Father's e-mail
Father's cell phone
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