Give It Up or Take It On Registration

Please register your fundraising with us so that a dedicated member of the fundraising team can support you and answer any questions you may have.

Registering: (required)

Please tell us what you plan to Give Up or Take On (required)

Have you set up your own online giving page (e.g. Just Giving, Virgin Money Giving etc)? (required)

YesNo

If yes, please enter the web address for your page below

Where would you like the money to go?

Ward or DepartmentGeneralCritical Journeys Appeal

If you picked ’Ward or Department’ please specify

Your details

Title (required)

First name (required)

Last name (required)

Address Line 1 (required)

Address Line 2

City/ Town (required)

Post code (required)

Email (required)

Date of Birth (required)

Main phone number (required)

Second phone number

Business/organisation details (if applicable)

Business/organisation name

Your role

Business address

Postcode

Main phone number

Social Media information

If you have a Facebook page or a Twitter account that you will be using for fundraising please add your page address or handle so that we can chat to you.

Facebook

Twitter

LinkedIn / Instagram

Additional Details

Declaration (required)

I agree to donate all the proceeds from the above event to Birmingham Children’s Hospital Charity. Under no circumstances will I divert any money raised in this name to any other organisation or individual, without the full knowledge and consent of Birmingham Children’s Hospital CharityBy ticking this box I understand and agree that Birmingham Children’s Hospital does not accept any responsibility for this event or activity. I understand and agree that I am undertaking this event or activity at my own risk and that Birmingham Children’s Hospital is not responsible for any risk, injury, loss or damage that may result and will not be liable for any claim which may arise

We would appreciate the opportunity to keep in touch with updates on the work of Birmingham Children’s Hospital Charity. If you would like to receive these updates, please tick the relevant boxes:

PostEmailSMSTelephone