CCF Fashion Show Alumni Registration

First Name *

Last Name *

Email Address: *

Date of Birth * +

Sex *

Male

Female

Please choose image of Alumni to upload or drag and drop image here. *

Primary Address

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Primary Language *

Applicant Cancer Information

Type of Cancer *

Date of Diagnosis * +

How long have you been cancer-free? *

Parent/Legal Guardian

Relationship to Alumnus

Mother

Father

Other Other

First Name

Last Name

Email Address

Primary Phone

Primary Language

Biography (to be filled out by alumnus)

The information collected on this form is used to create a biography about your child that will be printed in CCF’s promotional materials. Please answer all questions and provide details when appropriate.

Please give us and update about yourself! What grade are you in? Where do your work? *

What are your favorite activities? *

Tell us about your family life and anything else going on you would like to share! *

What would you like other children who are battling cancer to know? *

How did the Children's Cancer Fund help you? *

Describe your story from diagnosis to today: *

Backstage Buddy

Does Alumnus require a Backstage Buddy? *

Yes

No

Does the Alumnus require any medically necessary assistance the night of the fashion show? *

Yes

No

Who is the Alumnus' favorite Child Life Specialist, Nurse, or Camp Esperanza Counselor? *

T-Shirt Size

please select one T-shirt size *

	Youth Small	Youth Medium	Youth Large	Youth Extra Large	Adult Small	Adult Medium	Adult Large	Adult Extra Large
you must have at least one item	Youth Small	Youth Medium	Youth Large	Youth Extra Large	Adult Small	Adult Medium	Adult Large	Adult Extra Large

Consent and Release

I consent for (my child) to participate in the Children’s Cancer Fund Gala on Friday, April 22nd, 2022, and all other events relating to the Gala. I also consent to the use of his/her/my photograph and video image in any manner desired by CCF. I understand that this consent may result in my (child’s) picture or video being used in television, newspapers, magazines, websites, and other locations prior to, during, and after the event.

I also release CCF and its officers, directors, employees, and volunteers from any injury or damage that may arise from my (child’s) participation in the event. I agree that I (my child) will be present at the 2022 Gala and participate.

I understand that I (my child) must be present at the Gala (or send my child with an adult who is responsible for my child). I hereby present to CCF that when I (my child) participate(s) in any CCF event, I/he/she will have all needed approvals from my/his/her doctors.

Signature of Alumni *

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Signature of Parent (if alumni is below the age of 18)

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