Honour Your Caregiver

Thank you for making a gift.

* Mandatory Information

Personal Information

Tell us where to contact you.

*First Name:
*Last Name:
Organization Name:
* Mailing Address:
* City:
* State or Province:
* Postal Code:
* Country:
* Telephone Number:
Email:
Contact Person (if different from above):

If you were assisted by a Foundation staff member or volunteer, please tell us their name:

Donation Details

Choose where you want your donation to go.

Please direct my gift as follows (please choose one):


If "Other", please specify:

Payment Information

Tell us how you want to pay.

One-time payment:
I want to make a one-time payment of $

Multiple payments:
I want to make payments of $

NOTE: $10.00 minimum donation. Tax receipts will only be issued for gifts over $20.00 unless otherwise requested. For multiple payments, the first payment will be charged today. You may cancel at any time by notifying the Foundation.

This gift is in honour of

Name of caregiver:
Unit or Department:
Hospital:
Add a Personal Note:

*Note: The amount of your gift will not be disclosed

Recognition Preferences

We recognize donors by name in our publications.

Tell us how you want to be recognized.


OR
Publish my name as (if different from above)

Extra information

Let us send you more information.

Please send me information about how to make a gift to the Foundation through: