Chai Lifeline Canada Branch?*TorontoMontrealEvent Name*Please fill in "Chanukah Party" Family Name*Who is your Family Case Manager?Sara BlumLeah CarpinoShmuel RosenbergJen GelbergerRikki DrazinZahava EmanuelAtara EnglishHow many are attending in total? (including adults)*Email* Enter Email Confirm Email Phone/Cell*Guardian/Parent* First Last Who will be attending the event?Name of Child and Age* Would you like to request a volunteer?* Yes I need a volunteer No I do not need a volunteer Do you require transportation?* Yes I need a ride No I do not need a ride Limited availability - Please let us know if you need transportation and we will do our best to accomodateCommentsConsent 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.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.Signature*Use computer mouse or finger to signName of Signature* First Last Please type the first and last name of person who signedDate* Date Format: DD slash MM slash YYYY