TC Movie Day 2024

TC Movie Day

BJ's Restaurant in San Bernardino | The Look Cinemas in Redlands watching the movie Venom 3

Saturday, October 26, 2024

Time: 10:30am - 4:30pm
Redlands, CA

*CCF provides all meals, and transportation, if needed.

PLEASE REGISTER BY FRIDAY, OCTOBER 18, 2024 TO RESERVE YOUR SPOT.

Space is limited for those who would like to carpool with CCF. We will confirm availability once we receive your registration. Carpool will meet at the CCF Office in Loma Linda.
Teen Patient's Full Name*

First NameLast Name
Phone Number:*
Please enter a valid phone number.
May we send you text updates?*

YesNo
Email*
example@example.com
Are you (the teen) vaccinated (Covid-19)?*

YesNo
*Being vaccinated is not a requirement for attendance
Transportation

Space is limited for those who would like to carpool with CCF. We will confirm availability once we receive your registration. Carpool will meet at the CCF Office in Loma Linda.
Will your teen need transportation by CCF Staff? (current teens 14-18)*

YesNo
CCF TRANSPORTATION: I understand that I must be at the CCFSC office by 10:30am for DROP OFF & 4:30pm for PICK UP.

Yes
PARENT TRANSPORTATION: I understand that I must be at BJ'S RESTAURANT IN SAN BERNARDINO at 11:00am for DROP OFF & at 4:00pm for PICK UP at THE LOOK CINEMAS IN REDLANDS.

Yes
Parent Agreement

Childhood Cancer Foundation of Southern California, Inc./Teen Connection Program accepts no responsibility for the loss, damage, or theft of your property. Furthermore, I hereby agree to waive, release and discharge any and all claims for damages, death, personal injury or property damage which I may have, or which may hereafter accrue to me as a result of participation in the Teen Connection Program Event. This release is intended to discharge in advance Childhood Cancer Foundation of Southern California, Inc./Teen Connection Program and any and all agents involved in the Teen Connection Program, from any and all liability, claims, costs, expenses and /or damages (collectively referred to as “liability”) arising out of or connected in any way with my participation in the activities of the Teen Connection, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. Additionally, I hereby authorize any employee and/or volunteer of Childhood Cancer Foundation of Southern California/Teen Connection Program to authorize transport for the purpose of providing emergency medical care to any medical facility and further empower to authorize medical treatment deemed necessary by a licensed physician for my health and safety.
Signature*

Clear

PARENT PERMISSION SLIP

PERMISO DE PADRES
(TO BE COMPLETED BY PARENTS)
I give my teen permission to attend the CCFSC Teen Connection event to:

Movie Day | BJ's Restaurant & The Look Cinemas

*CCF TRANSPORTATION - Be at CCFSC office 11155 Mt View Ave Ste 105, Loma Linda on Saturday, October 26, 2024 at 10:30am. Returning on Saturday, October 26, 2024 at 4:30pm.

Parents/Guardians are responsible to have participants at the CCFSC office between 10:20 am and 10:30am on October 26, 2024 and be at the office to pick up by 4:30pm on October 26, 2024.

*PARENT TRANSPORTATION - Be at BJ'S RESTAURANT IN SAN BERNARDINO to drop off on Saturday, October 26, 2024 at 11:00am. PICK UP at THE LOOK CINEMAS IN REDLANDS on Saturday, October 26, 2024 at 4:00pm.

Parents/Guardians are responsible to have participants at BJ'S RESTAURANT IN SAN BERNARDINO at 11:00am on October 26, 2024 and be at THE LOOK CINEMAS IN REDLANDS to pick up the teen by 4:00pm on October 26, 2024.
Teen Patient's Full Name*

First NameLast Name
Parent's Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
May we send you text notifications?

YesNo
Emergency Contact Information #1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to Teen*
Relationship
Emergency Contact Information #2*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to Teen*
Relationship
If someone other than the parent is picking up the patient from the CCFSC office or the beach, please provide the following information:
Name of person picking up teen
Name of person picking up my teen
Relationship to teen
Relation
Phone Number
Please enter a valid phone number.
I hereby authorize, person named above to pick up my teen
Parents Signature

Clear
Medication
Is your teen on any medication?*

YN
Will medication need to be taken during trip?*

YN
Is the teen able to administer own medication?*

YN
How often must they be administered?*
Physical Limitations
Please indicate anything we should be aware of for the trip:*
Parent Waiver

Childhood Cancer Foundation of Southern California, Inc./Teen Connection Program accepts no responsibility for the loss, damage, or theft of your child’s property. Furthermore, I hereby agree to waive, release and discharge any and all claims for damages, death, personal injury or property damage which my child may have, or which may hereafter accrue to me as a result of participation in the Teen Connection Program. This release is intended to discharge in advance Childhood Cancer Foundation of Southern California, Inc./Teen Connection Program and any and all agents involved in the Teen Connection Program, from any and all liability, claims, costs, expenses and /or damages(collectively referred to as “liability”) arising out of or connected in anyway with my child’s participation in the activities of the Teen Connection, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. Additionally, I hereby authorize any employee of Childhood Cancer Foundation of Southern California/Teen Connection Program to authorize transport of my child for the purpose of providing emergency medical care to any medical facility and further empower to authorize medical treatment deemed necessary by a licensed physician for the health and safety of my child.
Parent Signature/Firma de Padre*

Clear

TEEN AGREEMENT
Lunch & a Movie -- San Bernardino/Redlands, CA | October 26, 2024

(1) I will remain with Teen Connection group throughout the entire trip and willingly participate in the activities.

(2) I understand that any bullying, name-calling, making fun of anyone in the group or outside the group, inappropriate language, behavior or dress WILL NOT BE TOLERATED. If the behavior is continuous and becomes a problem with the group, it will require prompt removal from future Teen Connection trips. Parents will be notified and asked to pick up the teen from the event location if the issue cannot be resolved during an event.

(3) I understand that all electronics including iPods, MP3 players, cell phones, etc. will remain put away and on silent while on the trip. Cell phones may only be used on emergency basis.

(4) Childhood Cancer Foundation of Southern California does not offer pick up or drop off options for teens at various locations along the route of the trip. Teens must have transportation to and from the office at the designated times.

(5) I understand that CCFSC will pay for meals and admission. I am responsible to bring spending money for souvenirs, snacks and other items I may want to purchase.

(6) Teen Connection accepts registration for events on first come basis. When registering for an event, be sure you can attend. If teen registers and cancels for an event it will be counted as a strike and each teen will only be allowed three strikes before being removed from future events.

Events requiring non-refundable pre-purchased tickets will be billed out to parents if teen does not attend.
Teen Signature*

Clear
Date*

MonthDayYear
Date
Parent Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

TC Movie Day

Transportation

Parent Agreement

PARENT PERMISSION SLIP

(TO BE COMPLETED BY PARENTS)

Medication

Physical Limitations

Parent Waiver

TEEN AGREEMENT