CHS-MC Member Dinner & Information Event
CanadInns Polo Park 1405 St. Matthews Ave. January 22nd, 2025
Adult 1
First Name
Last Name
Adult 1 Food Allergies/Restrictions
Family Contact Email
example@example.com
Adult 2
First Name
Last Name
Adult 2 Food Allergies/Restricitons
Does your family need help with transportation to CanadInns Polo Park?
Yes
No
Do you have a young child that will be accompanied by an adult? Your answer will help us plan for volunteers!
Yes
No
Child 1 Name
Child 1 Age
Child 1 Bleeding Disorder
Child 1 Food Allergies/Restrictions
Child 2
Child 2 Name
Child 2 Age
Child 2 Bleeding Disorder
Child 2 Food Allergies/Restrictions
Child 3
Child 3 Name
Child 3 Age
Child 3 Bleeding Disorder
Child 3 Food Allergies/Restrictions
Child 4
Child 4 Name
Child 4 Age
Child 4 Bleeding Disorder
Child 4 Food Allergies/Restrictions
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If there are more than 4 children, please list the remaining kids here with their name, age, bleeding disorder and any food allergies or restrictions.
Family Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
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