Event Registration Form

Chai Lifeline Branch?*
Event Name*
Family Name*
How many people from your immediate family will be attending?*
Who is your Family Case Manager?
Email*
Phone/Cell
Would you like to request a volunteer?
- Yes I need a volunteer
- No I do not need a volunteer
Comments:
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.
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 sign
Name of Signature*
First Last
Please type the first and last name of person who signed

Toronto