CONTACT INFORMATION
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Have you spoken to one of our fundraisers yet?
*
Yes
No
If yes, who is your fundraiser?
The name of the member of staff from Hope House Tŷ Gobaith supporting you with your fundraising activity!
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ABOUT YOUR FUNDRAISING
Your story
*
Please include as much detail as possible
Date of fundraising initiative
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Sponsorship Link
Please provide us with a quotation to support your story
Please say why you have chosen to support Hope House Tŷ Gobaith
Do you have a special reason for choosing to support Hope House Tŷ Gobaith?
For example: are you doing this in memory of someone special?
Share your pictures/videos
*
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CONSENT
Do you consent to your story and images/videos being shared on our social media channels and website?
*
Yes
By checking this box, you agree that Hope House Children’s Hospices will contact you, via the contact details you have provided
*
Yes
PRIVACY
Terms and Conditions
and
Privacy Policy
I agree to the Terms and Conditions and Privacy Policy
*
Yes
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