Teen Connection Application
In order to participate in Teen Connection events, please complete the following application. Event information is emailed to the registered email address. ---- Teen Connection ("TC") is a program of Childhood Cancer Foundation of Southern California geared to providing monthly support meetings/trips to adolescents ages 14-18 diagnosed with cancer. This program provides ample opportunities for teens diagnosed with cancer to meet with youth and adult facilitators to enjoy life as a teen, socialize, share experiences and receive peer support. All events are available to teens at no cost to them. To learn more visit our website: ccfsocal.org
Teen's Name
*
First Name
Last Name
Birthday
*
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Month
-
Day
Year
Date
E-mail
Mobile Number
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Area Code
Phone Number
Can we text you?
Yes
No
Parent's Name
First Name
Last Name
Parent's Number
-
Area Code
Phone Number
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Teen Interests
Please answer the following questions so we can get to know you a little bit!
What are your favorite colors?
What kind of movies do you like to watch?
What are your favorite sports?
What restaurants do you like to eat at?
What are some places you would like to visit?
What are your favorite TV Shows?
What kind of music do you listen to?
Do you have any hobbies?
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Teen Connection Event Expectations
We expect our trips to be the best of its kind in our community. In order for it to be safe, fun and enjoyable for all, we have some expectations we would like for you to discuss with your parent/legal guardian. After you have read this, please indicate that you agree with the stated expectations.
Authorization and Consent
I give permission for the release of photographs, videotapes, and related information regarding my child for news stories or for Childhood Cancer Foundation of Southern California, Inc.’s Publications. This may include revenue-producing products. I understand that I will not receive any compensation for this publication or broadcast.
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I have completed and reviewed this entire application. By electronically signing you agree to the previously reviewed statements and contract.
Teen's Signature
*
Clear
Parent's Signature
*
Clear
Signature Date
*
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Month
-
Day
Year
Date
SUBMIT
Should be Empty: