TC Lazer Legacy
Saturday, November 18, 2017
12:30PM -- 5:00PM

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, NOVEMBER 10, 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 12:30pm on November 18th to DROP OFF. *
I understand that I must be at the CCFSC office by 5:00pm on November 18th 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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