Bagel Loop Registration - Jewish Senior Citizen’s Centre

"*" indicates required fields

X/Twitter

This field is for validation purposes and should be left unchanged.

Who are you registering today?*

Participant Information*

First Name

Last Name

Age

Participant #1 Name*

First Last

Participant #1 Age*

Participant #2 Name

First Last

Participant #2 Age

Participant #3 Name

First Last

Participant #3 Age

Participant #4 Name

First Last

Participant #4 Age

Your email address*

How many people in your party are Vegetarian?*

Please enter a number from 0 to 4.

Each participant is required to complete a waiver.

You can download and print your pledge form and start collecting donations today!

Final payment of your total listed below can be paid in-person at the Centre or via e-transfer to jdic@shaw.ca

See you at Victoria Park!

Total