1 Champion & Gift Information 2 Donor & Billing Information 3 Review Gift Information Honour your Champion of Care Our Champion of Care program offers patients, their families and friends a special way to say thank you and pay tribute to an employee, physician or volunteer at Queensway Carleton Hospital who provided exemplary patient care or service. When you make a donation to honour a Champion of Care, we will send your personal message of thanks and appreciation to your Champion. Your Champion will also receive a commemorative pin that he or she can wear with pride. Champion of Care Information Champion title: Mr. Ms. Mx. Mrs. Miss Dr. Required My Champion's full name is: Personal message of thanks and appreciation to be sent to your Champion: Please check if QCH Foundation and QCH may share your message via website, newsletters, etc. Your personal information will remain confidential Queensway Carleton Hospital and Foundation may share your champion message on websites, newsletters and hospital property screens. Your personal information will not be shared. QCH Foundation communications approval. Queensway Carleton Hospital and Foundation may share your champion message on websites, newsletters and hospital property screens. Your personal information will not be shared. Gift Information Please enter your donation information. Field Is Required Please select a donation amount: $50.00 $100.00 $250.00 $500.00 Enter an amount Enter amount Next Cancel