TC MOVIE NIGHT
Saturday, July 15, 2017
Time: TBA (will announce time the week of event)

Meeting at the CCF Office
11155 Mt View Ave, Suite 105
Loma Linda, CA 92354
*CCF provides transportation, dinner, and admission.

PLEASE REGISTER BY FRIDAY, July 7TH, 2017 TO RESERVE YOUR SPOT.

Sign-ups taken on a first-come basis. LIMITED SPACE AVAILABLE. If teen registers and does not attend the event, parent is responsible for the cost of admission.

Teen Patient's First Name
Your answer
Teen Patient's Last Name
Your answer
Contact Cell Phone
Your answer
Can we text you updates?
Contact Email Address
Your answer
Movie Choices
Select the Movie You Would Like to Watch
I understand that I must turn in a permission slip to attend this event.
I understand that I must be at the CCFSC office by TBA on July 15th for pick up.
I understand that I (Parent) will be responsible for the cost of admission if my teen does not attend the trip.
PARENT'S FULL NAME (This serves as an electronic signature)
Your answer
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