In Kind Donation Form - Childrens Hospitals And Clinics Of Minnesota
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2In-kind donation form
Thank you for your donation to Children’s Hospitals and Clinics of Minnesota.
Please help us properly acknowledge your gift by completing steps 1-3 of the form below.
Step 1: Donor information
Date:_________________________
Donor is: Organization/Company
School
Adult (over 18)
Child (under 18)
Donor name(s):_________________________________________________________________________
Name of organization/company contact or parent/guardian if donor is under 18:
______________________________________________________________________________________
Address: _________________________________________
Phone:___________________________
(Street address)
Home
Work
Cell
__________________________________________
Email:___________________________
(City, state, zip code)
I am a Children’s patient / family member
I would like to remain anonymous
No receipt required
Step 2: Donation information
Donation description and quantity: _________________________________________________________
_________________________________________________________
Total value of donation:
$50
$150
$250
$500
$1,000
Other:___________________
Step 3: Tribute information
This donation is:
In memory of _____________________
In honor of _______________________
Please send an acknowledgement card on my/our behalf to:
Name: _______________________________________________
Address:______________________________________________
City:___________________________________ State:______________ Zip:_____________________
Please sign my/our card:_____________________________________________________________
STAFF SECTION
Employee accepting donation: ___________________________________________________________
Department accepting donation:
Concierge/Welcome Desk
Child Life
Security
FRC
Star Studio
Families as Partners
Foundation
Vol. Services
Please send completed form to the Children’s Foundation:
Mailing address: Children’s Foundation
Internal Mail Stop: 35-115A
2910 Centre Pointe Drive
Email:
Roseville, MN 55113
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