Fundraiser's details

Title*

Full Name*

Full address (incl. postcode)*

Contact number(s)

Contact email*

Date of birth*

How did you hear about us?*

Please selectWord of MouthSocial MediaYTHC WebsiteInternal CommunicationsNewsletter/e-Newsletter

Name of your Just Giving page (if applicable)

We'd love to know your reasons for choosing to support York & Scarborough Hospitals Charity*

Would you like your money to benefit a specific appeal orspital department? If yes, please state which appeal or department

We are here to guide and support you through your event or activity and can advise on health and safety, council licenses and much more. Please give us as much information as possible about your activity and we will ensure you have all the relevant information to help make your event a success!

Fundraising event or activity

Name of event or activity*

Date of event or activity*

Where will the event/activity take place?*

Please provide the full address of where the event/activity will take place*

Would you like a member of the CharityTeam to attend your event? (This may not always be possible, but we will do our best to accommodate this request)*

Please selectYesNo

Are you happy for us to include details of your fundraising on our website, social media and newsletter?*

Please selectYesNo

I give permission for York & Scarborough Hospitals Charity to use any photographs I may send, for use in their literature and promotional materials, which may include their website and social media channels.

Fundraising materials

We can provide some materials to help with your fundraising. We kindly request a donation of £10 per running vest and £5 per T-shirt. Please state how many of each you would like.

Sponsor forms*

Please select12345n/a

T-shirt - S, M, L or XL (please state size & quantity)

Running vests: S, M, L or XL (please state size & quantity)

Collection tins*

Collection buckets*

Declaration

1. I acknowledge that I am undertaking this event or activity entirely at my own risk and that York & Scarborough Hospitals Charity shall not be liable in any way for damage, injury or loss that might occur as a result of the event/activity

2. I will ensure that all fundraising is conducted in a safe and legal manner

3. I agree to pay all charitable proceeds of the event to York & Scarborough Hospitals Charity as soon as possible after the event/activity

4. I understand that York & Scarborough Hospitals Charity will use the funds in a way that is most appropriate for the needs of York & Scarborough Hospitals NHS Foundation Trust, in line with our charitable aims and I cannot request purchase of specific items

5. I understand that I should seek medical advice from my general practitioner if I am in any doubt about my physical ability to hold or take part in this event/activity

I have read and understand all of the above and by submitting this form agree to adhere to them*

YesNo

I would like to hear about where money raised is helping in our hospitals and future fundraising events and campaigns (please select preferred method of contact)*

Please selectBy EmailBy PostBy PhoneNo Thanks

I would like to hear about volunteering opportunities when they arise (please select preferred method of contact)*

Please selectBy EmailBy PostBy PhoneNo Thanks

If you would like to contact the Charity Team, please either email charity.fundraising@york.nhs.uk or phone 01904 724521