I Care. I Share. Care Club Members

I Care. I Share. Care Club Members

Thank you for being a Care Club Member! Your commitment to Children’s National Hospital enables us to be a pediatric leader that helps children grow up stronger. If you wish to claim your I Care. I Share. thank-you gift, please complete this form. Your gift will mail to the non-Children's National address you provide.
Date of Request:*

MonthDayYear
Date
Requestor's Name:*

First NameLast Name
Employee ID:*
Email*
example@example.com
I would like to receive my I Care. I Share. thank you item

YesNo
Non-Children's National Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Update to Existing Recurring Gift:
Comments or Questions for the I Care. I Share. Team:
By submitting this form, I agree that the requested payroll deduction will be sent to Children's National payroll team for processing on the next payroll.
Should be Empty: