Make A Gift - Queensway Carleton Hospital Foundation

Our Champion of Care program offers patients, their families and friends a special way to say thank you and pay tribute to an employee, team, 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 to wear with pride.

All fields indicated with an asterisk are required.

Champion of Care Information

Champion's Department:

Champion's Full Name:

Personal message of thanks and appreciation to be sent to your champion:

Please Select a Gift Amount

Field Is Required Enter A Gift Amount:

$50.00

$50

$100.00

$100

$250.00

$250

$500.00

$500

Other Amount

Enter amount

Donor Information

Make this gift on behalf of an organization

Organization Name:

Donor Title:

Donor First Name:

Donor Middle Name:

Donor Last Name:

Donor Street 1:

Donor Street 2:

Donor City:

Donor Province/State:

Donor Postal/ZIP code:

Donor Country:

Donor Phone Number:

Email Address:

Billing Information

My Billing Information is the same as Donor Information

Title:

First Name:

Last Name:

Street 1:

Street 2:

City:

Province / State:

Postal / Zip Code:

Yes, I would like to receive the latest and greatest news and stories from Queensway Carleton Hospital Foundation by email.

Payment Method:

Credit Card

Check Information