TC MOVIE DAY & ESCAPE ROOM
Saturday, July 21, 2018
Drop Off Time: 12:30pm
Pick Up 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 16TH, 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 ON TIME by 12:30pm on July 21st to DROP OFF. *
I understand that I must be at the CCFSC office by TBA on July 21st 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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