Event Registration Form - Chai Lifeline Canada

Registration Is Closed.
Event at Capacity

Chai Lifeline Canada Branch?*
Event Name*
First Name*
Last Name*
Hidden
Who is your Family Case Manager?
The show is separate seating, please let us know how many women's seating tickets you require:
Please enter a number from 1 to 6.
6 Tickets Max per Family. If you need additional tickets please leave a note in the comments box.
The show is separate seating, please let us know how many men's seating tickets you require:
Please enter a number from 1 to 6.
6 Tickets Max per Family. If you need additional tickets please leave a note in the comments box.
Hidden
FERRY RIDE: Please fill in the blanks below and let us know how many people fall under these age brackets:
Child: 2 And Younger Child: 3 - 14 Years Old Young Adult: 15 - 19 Years Old Adult: 18 - 64 Years Old Senior: 65+
Ferry rides are divided by age - please populate the boxes above with the number of people in your family who will be joining us on the ferry boat to Center Island.
CENTERVILLE RIDE PASSES

To View Available Attractions, {{https://centreisland.ca/rides-attractions/}}
Hidden
How many children are UNDER 4ft tall?

Please only list the # of children who will want to go on rides
Hidden
How many children are OVER 4ft tall?

Please only list the # of children who will want to go on rides
Phone/Cell*
Email*
Enter Email Confirm Email
Hidden
Select Time Slot
Select All
1:00 PM - 2:00 PM
2:30 PM - 3:30 PM
Please let us know your choice of time you would like to attend. Please select as many as your available for. We will do our best to accommodate.
Comments:
Hidden
Consent Agreement
The following consent agreement must be signed by parent or a legal guardian: I understand that unless I have detailed any specific restrictions to activities on this form, I accept full responsibility for my child’s/children’s safety. I agree to release and hold harmless CHAI LIFELINE CANADA and all of their representatives and volunteers from any claims, costs, expenses and/or damages which I or my child/children may sustain or incur by joining. In the event of any lawsuits or claims for damages against CHAI LIFELINE CANADA, their representatives or volunteers, I agree to identify and hold harmless CHAI LIFELINE CANADA and their representatives for any damages arising from such claims.
Hidden
Do You Need a Volunteer?
Yes
No
PLEASE KEEP IN MIND: We will do our best to provide you with a volunteer, but we cannot guarantee.
Hidden
Photo Release*
Yes, We are released
No, We are not Released
Full permission is granted to Chai Lifeline Canada and it’s representatives to photograph any child/teen, and to use, publish, and release for publication any photos taken at this event.
Hidden
Signature
Use computer mouse or finger to sign
Hidden
Name of Signature*
First Last
Please type the first and last name of person who signed
Hidden
Date*
DD slash MM slash YYYY

Toronto

300A Wilson Ave.
Toronto, Ontario, M3H 1S8
Phone: 647.430.5933
Fax: 416.628.1597

Montreal

4900 Jean Talon Ouest, #220 Montreal, Quebec H4P 1W9
Phone: 514.667.7041

Crisis Intervention

1 (800) 556-6238
[email protected]

Newsletter subscription

At Chai Lifeline Canada we are passionately devoted to alleviating the burden of those facing medical challenge. From the moment of diagnosis, through the arduous months and years, in good times and bad, Canadian families have discovered that Chai Lifeline Canada is a friend for life.

Chai Lifeline Canada. Fighting Illness with Love.

DONATE

PROGRAMS & SERVICES

GET INVOLVED

CONTACT

Get social with us

Instagram Facebook-f Linkedin-in Pinterest-p X-twitter

Privacy Policy

Chai Lifeline Canada is a registered Canadian charity
Reg. No. 85656 5536 RR0001
Chai Lifeline Canada is a member of the OCGA

©2025 Chai Lifeline Canada. All rights reserved. Design & Development by LeverageIT. Chai Lifeline Canada is a registered Canadian charity. Reg. No. 85656 5536 RR0001. Chai Lifeline Canada is a member of the OCGA

36 HOURS.

$500,000

2X MATCH!

Minimum $18 donation per tribute card

Entrance ticket added to cart View Cart