H&S Donation 2017

Donation - without tax receipt

Please fill in this form for our records. You will then be brought to our store to select a donation amount then for payment. Thank you!

* Indicates required field

Name *

First

Last

Email *

Phone Number *

I wish my donation to remain anonymous *

Yes No

Please enter the name(s) of the student(s) you are supporting with this donation.

Student #1 Name *

Select One *

Student #2 Name *

Select One *

Student #3 Name *

Select One *