TC Application

TC Application

Childhood Cancer Foundation of Southern California is pleased to offer a Teen Connection program for teens ages 14-18 years who have or have had cancer. We hold meetings/outings throughout the year. Outings are only for the teen patient.

In order to participate in Teen Connection outings, please complete the following application. Event information is emailed to the registered email address.

Contact Angelica if you have any questions: or (909) 558-3419.

Questions marked with * are required.

First Name: *
Last Name: *
Email: *
Phone Number: *
Birthday: (Format: MM/DD/YYYY) *

Please answer the following questions so we can get to know you a little bit!
Do you like pizza?
  • Yes
  • No
If yes, what toppings?

What type of sodas/drinks do you like?
What kind of snacks do you like?
What restaurants do you like to eat at?

What kind of food do you like to eat?

What are your favorite colors?
What kind of movies do you like to watch?
What are your favorite sports?
What are some places you would like to visit?
What are your favorite TV Shows?
What kind of music do you listen to?
What are some of your interests?
Teen Connection Event Expectations *
We expect our trips to be the best of its kind in our community. In order for it to be safe, fun and enjoyable for all, we have some expectations we would like for you to discus with your parent/legal guardian. After you have read this, please indicate that you agree with the stated expectations.

1.     We expect each participant and CCFSC staff and volunteers to treat the other members of the group with mutual respect and consideration. On our trips, we will have many opportunities to interact with the public. We expect participants to conduct themselves in such a way that upholds our high standards.

2.     During our event, the use or possession of alcoholic beverages, cigarettes and drugs, or sexual activity by participants are not allowed.

3.     Participants are expected to adhere to the event schedule and report to activities on time.

4.     Dress in appropriate attire with no inappropriate symbols or language on them.

5.    Events registration is on first come basis. When registering, be sure that you will be able to attend. If teen registers and cancels for an event it will be counted as a strike, placing them on the waitlist for future events. Each teen will only be allowed 3 strikes before being removed from future events. Events requiring non-refundable pre-purchased tickets will be billed out to parents if teen does not attend.

*     If at any time during the trip the guidelines are broken or the staff/volunteers determine that the person’s behavior detracts from a positive experience, the parent(s) will be notified that their teen’s activities will be restricted and/or if necessary the parent(s) will need to pick up their teen at the location of the event.

  • Agree

Authorization and Consent: *

I give permission for the release of photographs, videotapes, and related information regarding my child for news stories or for Childhood Cancer Foundation of Southern California, Inc.’s Publications.

This may include revenue-producing products. I understand that I will not receive any compensation for this publication or broadcast.

  • Agree

I have completed and reviewed this entire application. By electronically typing in your full name you agree to the above statement and contract. *

Teen's Full Name *

Parent/Legal Guardian's Full Name *