Southlake Regional Health Centre Foundation

Thank you for your generous one-time gift!

Your commitment to Southlake will help ensure that your family, friends and neighbours have access to leading edge care, close to home.

Please complete the form below to complete your tax-deductible donation now.

Are you looking to make a corporate donation? If so, click here.

If you have any questions about your gift, please Southlake Foundation at 905-836-7333 or foundation@southlake.ca.

Field Is Required Select Gift Amount:

$500

$100

$50

$25

Enter amount

Field Is Required Gift Designation:

Use my gift where it is needed most.

Direct my gift to:

Where would you like to designate your gift to?

*Please Note: If you selected ‘other’ rather than one of the Hospital’s identified priorities we may need to contact you to ensure that your donation can be put to work as quickly as possible in the area of the hospital you wish to support.

Donor/Receipt Information

Title:

First Name:

Last Name:

Address:

City:

State/Province:

ZIP/Postal Code:

Country:

Preferred Phone Number:

Email Address:

Yes, I would like to make this donation anonymously.

I am proud to be part of the Southlake Family as a physician, staff or volunteer

Southlake Foundation is dependent upon the generous support of donors and volunteers to fulfill its mission. We collect your personal information to process your donation, issue a tax receipt, and to demonstrate the impact of your gift at work. Your personal information will not be sold or traded with other organizations. For more information about our privacy practices, view our Privacy Policy or contact us at Foundation@southlake.ca

Yes, I would like to receive occasional email updates from Southlake Regional Health Centre Foundation. To opt-out of receiving these communications, please uncheck the box.

Yes, I would like to receive physical communication from this organization.

Payment Information

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?