Extra Life – Tax Receipt Inquiry Form

Contact Full Name *

Donation Records:

Donation Date 1 (dd/mm/yyyy) *

Donation Amount 1 *

Donation Date 2 (dd/mm/yyyy)

Donation Amount 2

Donation Date 3 (dd/mm/yyyy)

Donation Amount 3

Donation Date 4 (dd/mm/yyyy)

Donation Amount 4

Donation Date 5

Donation Amount 5

Name of Participant Supported *

Which Children's Hospital Foundation did you support? *

Street Address *

Address Line 2

Province *

City *

Postal Code *

Email *

Phone *

Message