Your Gift Information

Donation Amount*
  • $50
  • $100
  • $150
  • $200
  • $250
  • Other $
My gift will benefit*
  • General Fund: supports the overall functions of Home Instead Charities, while giving flexibility to support the area of greatest need in an unrestricted capacity.
  • Give65 Incentive Fund: provides matching and bonus grants to Give65 charitable organizations serving aging adults.
  • Be A Santa To A Senior - General: provides holiday gifts to less fortunate aging adults during the holidays.

Tribute Information

If your gift is in memory or in honour of someone, or you are celebrating a Home Instead CAREGiver, please let us know by completing the following tribute information.  With your authorization, we will send a letter to the honouree or the family of the one you have remembered with this gift. Gift amounts are kept confidential.  If you gift is not in memory, honour or celebration of someone, please skip to the "Your Contact Information" section. 

Tribute Name
Name of the person you would like us to notify about this gift
Mailing address of the person you'd like us to notify. If you are celebrating a Home Instead CAREGiver, please indicate the Home Instead office address.

Share a brief note if you would like...

Your comments are shared in an acknowledgment letter to the family of the remembered, or to the individual honoured. If you are celebrating a Home Instead CAREGiver, please share why you are recognizing this CAREGiver. By sharing this informaiton, you are giving permission to include this information in the special letter.

Your Contact Information

Company Name
How would you like your name to appear for recognition?*
Confirm Email*

Payment Information

After you complete this form, select Submit to enter your payment details into our secure transaction processor. Your submission will be processed when you finalize your secure payment information.
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