Consent for care and looking after your personal information

Thank you for supporting Hospiscare

Your donation amount:

Your name

*Title:

*First name:

*Last name:

Phone:

Your card billing address

*Address line 1:

Address line 2:

*City:

*Postcode:

*Email address:

By providing us with your email address you are agreeing to be contacted in this way. You can opt-out of receiving updates from us below.

THE REASON FOR YOUR DONATION

*Please select one option:

*Please tell us why you held this event:

*Name of company:

*Name of Event:

Please tell us about your donation:

Name:

Relationship to you:

Using your information

Supporters of Hospiscare are precious and we will not sell your details onto anyone else. We would like to keep in touch with news about our work and fundraising activities. If you DO NOT wish us to contact you by the following means please tick the relevant box:

Phone

Mail

Gift AID your donation

If you are a UK taxpayer we are able to claim an extra 25p for every £1 you donate. On the next page please read the Gift Aid statement and tick if you are eligble for Gift Aid to be claimed from your donation.

Consent for care and looking after your personal information

To find out about giving consent for care, please click here

To find out how we look after your patient record and who we share it with, please click here