OutCare Donation Form

Contact Information

Confirm Email*

Gift Information

Donation Amount*
Please fill in this box if you wish to designate your gift to a certain hospice in Eastern Ontario. 100% of your donation will be given to your charity. If you choose more than one, your gift will be divided accordingly. If you leave this area blank, your gift will go to the area of greatest need. Thank you for your support.

Tribute Information

If this is a tribute gift, please complete the following information.

Is this gift in Memory/Honor/Celebration of someone?
Tribute Name
Send Notification of Tribute Donation to Family?
Name and Address of Family Member (required for sending notification)

Payment Information

Payment Type
We only accept credit/debit card payments. After you complete this form, select Submit to enter your card details into our secure transaction processor. Your submission will be processed when you finalize your secure payment information.
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