Teen Connection Application

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 is a life-affirming peer-support program by Childhood Cancer Foundation of Southern California for teenage cancer patients and survivors. Designed for youth ages 14–18, this program offers a safe, supportive space where teens can connect, socialize, and simply enjoy being teens together.

Through Teen Connection, participants meet with caring youth and adult facilitators to share experiences, build friendships, and find encouragement from others who truly understand their journey. All activities and events are provided free of charge to participants.

To learn more, visit ccfsocal.org/teen-connection
Teen's Name*

First NameLast Name
Birthday*

MonthDayYear
Date
E-mail
Mobile Number

Area CodePhone Number
Can we text you?

YesNo
Parent's Name

First NameLast Name
Parent's Number

Area CodePhone Number

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?

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.

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*

MonthDayYear
Date
Should be Empty:

Teen Interests