Teen Group Membership Registration

The fee to register for the Teen Group is $50 per person. The Teen Group is open to children aged 13 to 19 who have a parent or guardian who is or becomes a Peretz Community Member. Fill out the form completely. Then print, enclose a check made out to ILPCJS for $50 per child, and mail to ILPJS, P.O. Box 1556, Highland Park, NJ 08904.

Teen 1 Name: *

Teen 1 School Grade: *

Teen 1 Email Address:

Teen 1 Cell Phone Number:

Parent Name: *

Parent Email Address: *

Home Phone Number:

Parent Cell Phone Number: *

Parent Street Address: *

City, State, Zip: *

Photo Release:

I/We permit the use of photographs that depict me/us and my/our child/children for use on the Peretz website and in Peretz marketing materials. Your consent is important to attract new members and keep our community vibrant. No names will be associated with these photos.

Potential Members:

If you know of any other teens who may be interested in learning more about the Peretz Teen Group, please add their names, phone numbers, e-mail in below box.

Number of Teens