Event Registration Form - Chai Lifeline Canada

Registration Is Closed.
Event at Capacity

Chai Lifeline Branch?*
Event Name*
Would you like to join the event?*
- Yes
- No
Name*
First Last
Email*
Phone/Cell*
How many adults will be joining?
How many children will be joining?
Please list your kids names and their ages:

Please list the name of your kids and their ages so we can ensure they get gifts they will love!
Please select dietary restrictions if they apply:
- Vegetarian
- Gluten Free
*This event is NUT FREE
How many meals for your family need to be Vegetarian or GF?
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Would you like a ride up to the event for your family?*
- Yes
- No
Who is your Family Case Manager?
Comments:
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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.
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Signature*
Use computer mouse or finger to sign
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Name of Signature*
First Last
Please type the first and last name of person who signed