REQUEST TO FUNDRAISE

Our Fundraising Guidelines document will assist you with ideas and requirements for your fundraising
proposal. If you would like to organise a fundraising event to support the Childrens Health Foundation
Queensland, please complete this Request to Fundraise form, then return it to the Community
Partnerships team at the Childrens Health Foundation Queensland for review. If approved, you will
receive a letter within seven working days authorising you to fundraise on our behalf. Thank you for
considering the Childrens Health Foundation Queensland as your beneficiary.
Name of person organising the event / activity:_____________________________________________
Name of organisation (if applicable):_____________________________________________________
Street Address:_____________________________________________________________________
Suburb:__________________________________State:____________________Postcode_________
Postal address (if different to above):____________________________________________________
Telephone (work):________________________(home):_________________Mobile:______________
Facsimile:________________________________Email:_____________________________________
Title of Event:_______________________________________________________________________
Proposed date of event:_____________________________ Start and finish time:_________________
Location of event:_____________________________ Number of proposed participants:___________
Who are you targeting to attend the event?:_______________________________________________
Please describe in detail how the event will work (you may submit information on a separate sheet if you
require more space):_________________________________________________________________
__________________________________________________________________________________
By what means will you be raising money? eg. ticket sales (price?),raffle, auction, sponsorship:_______
__________________________________________________________________________________
Will you be raising money for any other organisations at the event?: ____________________________
If yes, please advise names: ___________________________________________________________
Declaration:
I declare that all information provided to the Childrens Health Foundation Queensland in this proposal is
true and accurate. I have read the Fundraising Guidelines and agree to abide by conditions contained
within the Guidelines. I agree to indemnify the Childrens Health Foundation Queensland against any
claims for injuries or damages, or monies owed, arising out of the event I undertake. I understand the
Childrens Health Foundation Queensland has the right to withdraw my approval to fundraise if I am in
breach of any of the Fundraising Guidelines. If requested, I will provide full financial audit of monies
collected and /or, prizes obtained.
Name: ________________________________
Position:

Signature: _________________________________