TC Knott's Scary Farm
Saturday, September 30, 2017
4:30pm - 2:00am

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, SEPTEMBER 1, 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 COST OF ADMISSION.

Teen Patient's First Name
Your answer
Teen Patient's Last Name
Your answer
Contact Phone
Your answer
May We Send You Text Notifications?
Contact Email Address
Your answer
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 4:30pm on September 30th to DROP OFF.
I understand that I must be at the CCFSC office by 2:00am on September 30th to 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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