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*
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How many adults will be joining?
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How many children will be joining?
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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 meal choice:
- Falafel
- Chicken
*This event is NUT FREE
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How many meals for your family need to 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

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.

Get social with us

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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