Teen Board Application

Annual Membership Requirements

Membership meetings TBD based on events
Annual dues are $40 with the calendar year being September 1 – August 31
CCF will reach out to Teen Board database with opportunities throughout the year as needed
Potential service hours annually: 20 - 25
At least four service opportunities annually:

Valentine’s Day Goody Bag Collection/Assembly
Team Michael Toy Drive in June (90% of work in April and May)
Fall Fundraiser
December Toy Drive

First Name *

Last Name *

Date of Birth *

Name of the school you attend: *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Parent's Email Address *

Teen's Email Address

*

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T-Shirt Size (choose one)	Small	Medium	Large	XL	2XL	3XL

Waiver Statement

I, the undersigned, assume full and complete responsibility for any injury, accident, or illness that may occur during my participation in this event or while I am on the premises of the event. I hereby release and hold harmless Children’s Cancer Fund and any of its officers, directors, employees, associates, sponsors, promoters, and all other persons and entities associated with the event or their agents or employees, or otherwise. I assume all risks associated with this event. I further grant my permission to use any photographs, videotapes, motion pictures, recordings, or any other record of this event. I have read the forgoing and certify my agreement by this signature, and my parent’s or guardian’s if under 18 years old.

Participant's Signature *

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Parent/Guardian Signature (if entrant is under 18 years of age)

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Annual Membership Payment

Continue to pay $40 Annual Fee:
*

$40.00