Event Registration Form II - Chai Lifeline Canada

Chai Lifeline Canada Branch?*
Event Name*
First Name*
Last Name*
Who is your Family Case Manager?
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Please let us know your families numbers!
Child: 2 And Younger Child: 3 - 12 Years Old Young Adult: 13 - 17 Years Old Adult: 18 - 64 Years Old Senior: 65+
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How many children are attending?
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How many adults are attending?
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Phone/Cell*
Email*
Enter Email Confirm Email
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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.
Please list any allergies or dietary restrictions:
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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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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.
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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.
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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
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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.

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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

Minimum $18 donation per tribute card

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