Noogie Nights 
Please fill out the form below with your contact information and a member of our staff will be in touch shortly with live class information. If you have multiple children participating, please complete this quick form again for each additional child. Thank you!
Sign in to Google to save your progress. Learn more
Child's first name *
Child's last name *
Child's age
Parent/Guardian Name(s) and Phone Number *
Parent/Guardian Email Address(es) *
What is your child's connection to cancer? *
Virtual Programs Confidentiality and Safety
I agree to CSC's confidentiality and safety policy. *
Have you attended a CSC program before? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Cancer Support Community of Greater Ann Arbor. Report Abuse