Give A Gift To A Child In Hospital

How much would you like to donate?*

$25

$50

$100

$250

$500

Custom

Frequency*

One Time

Monthly

Who's giving today?

We’ll never share this information with anyone.

Name*

Salutation First Middle Last

Company Name

Is this donation on behalf of a company or personal?*

Personal Donation

Company Donation

Other

Anonymous

Make this an anonymous donation

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Please add me to the mailing list*

In compliance with Canada's Anti-Spam Legislation (CASL), if you wish to receive further electronic communications from JPCHF, please select 'yes'.

Yes

No

Birthday

Phone*

Designate This Gift

Would you like to choose a fund to designate this gift to?*

Yes, let me choose

No, give where needed most

Designated Fund

Dedicate this Donation

Yes, please

No, thank you

Dedication Type

In honour of

In memory of

Honouree Details

First Last

Would you like us to notify anyone of your donation?

Yes, mail a card

Yes, send an eCard

No thanks

Message

Recipient

First Last

Recipient Email

Recipient's Address

Street Address Address Line 2 City Province Postal Code

Help us cover the processing fees

Yes, please add $0.00 to my transaction

3% of donation, to a maximum of $25

Donation Total

Processing Fee

: $0.00

Processing Fee (Max)

:

Credit Card*

For American Express, please call the Foundation office at 306.931.4887.

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MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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