Event Registration Form II

  • Child: 2 And YoungerChild: 3 - 12 Years OldAdult: 13 - 64 Years OldSenior: 65+
  • Hidden
  • Hidden
  • Hidden
    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.
  • Hidden
    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.
  • Use computer mouse or finger to sign
  • Please type the first and last name of person who signed
  • DD slash MM slash YYYY


300A Wilson Ave. Toronto, Ontario, M3H 1S8

Phone: 647.430.5933


1090B Pratt. Montreal, Quebec, H2V 2V2

Phone: 514.667.7041

Crisis Intervention

Email: [email protected]

Phone: 1 (800) 556-6238