CHNOLA Community Fundraiser

Community Fundraisers Online Application

Welcome,

Thank you for your sincere interest in helping Children’s Hospital New Orleans. Please know that your support means the world to us. The hospital depends on the generosity of people like you to continue providing every child treated at Children’s Hospital with the same level of expert medical care that they deserve.

Date*

Sponsor Information

Name*

First Name

Last Name

Company/Organization Name (if applicable)

How would you like to be communicated with?*

Text Call Email Zoom

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Cell Phone: (10 digits)*

Business Phone (10 digits)*

Email*

Company/Organization Website*

Fundraiser Information

Name of Fundraiser*

First Name

Last Name

Type of Fundraiser*

Date*

Time of Fundraiser*

Description of Fundraiser (please be specific)*

Location*

Has this fundraiser taken place before (please select from drop-down)?*

If yes, who was the beneficiary?

Does your fundraiser require permitting and/or license? *Please note: As with any fundraising event or proposed raffle, please adhere to federal, state and local laws regarding gaming permits.*

Budget/Fundraising

Will Children's Hospital be the sole beneficiary of this event (please select from drop-down)?*

If no, please list other beneficiaries:

Approximate number of participants*

Anticipated gross revenue*

Anticipated expenses*

How will expenses be paid?*

Anticipated net revenue*

Anticipated donation to Children's Hospital*

Will the fundraiser be sponsored or underwritten by a company or organization business (please select from drop-down)? *

If yes, please specify all sponsors involved

Price structure of fundraiser (entrance fee, ticket cost, etc.) *

Briefly describe how funds will be raised ( i.e. ticket sales, collections, sponsorship, auction, raffle, etc.) *

Name of insurer (*Children’s Hospital may require the insuring of any special event/fundraiser. The hospital assumes no liability related to special events conducted on its behalf.)*

Because the hospital solicits a large number of local businesses, prior approval may be necessary before asking for donations. Please list all businesses, civic or social organizations, or foundations which will be or have been solicited for underwriting, sponsorship, in-kind giving, auction items or other contributions for this event. *

Publicity and Promotions

For publicity purposes, a contact name and number that can be publicly listed:

Name*

First Name

Last Name

Phone*

Email*

Website*

How will the event be publicized (social media, press releases, flyers, TV/Radio, newspapers, website)? *

Do you plan to use the Children’s Hospital logo or name on event materials? Review and approval must be received prior to printing materials with the hospital logo or name. *

Signature*

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