10 year reunion picnic

Chicago Survivors 10-year reunion picnic

Who is Eligible? Immediate relatives of homicide victims who have received services from Chicago Survivors are welcome to register. We will also having out annual back to school supply giveaway so please register each child. This event is designed to bring warmth, support, and a festive spirit to families impacted by loss. Please complete this form in it’s entirety.
Gaurdian Details
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
smallmediumlargex large2 x3 x
Eligibility Details
YesNo
Name of lost loved one due to Homicide:*
Youth & Gift Preferences
IF THIS SECTION IS NOT COMPLETED FULLY FOR EVERY CHILD, YOUR SUBMISSION WILL BE REJECTED!!!

YOUTH INFORMATION: List EACH YOUTH and their grade

Photo/Video Release

Photo/Video release: I understand that I will not be paid for these photographs and have no rights to them. I am participating as a volunteer. I hereby waive any right to inspect or approve the finished photograph or advertising copy or printed matter that may be used in conjunction therewith or to the eventual use that it might be applied.

By submitting this form you agree to the photo release policy
yesno
Check 'Yes' if you are asurvivor individual or family who may be open to sharing their stories throughinterviews, photography, or video, and a quick follow-up (e.g., a brief phoneinterview, scheduling call, or any additional steps needed before confirmingtheir participation) for Chicago Survivors’ 10-Year Anniversary GalleryProject. Chicago Survivors Staff will reach out to you if 'yes' isselected.

yesno
Should be Empty:

Chicago Survivors 10-year reunion picnic