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This form will guide you through registering with The Royal Children's Hospital (RCH) Foundation.

Have you read our Terms and Conditions yet? If not, please read them before completing this form. The Fundraising Terms and Conditions highlight what you need to know to become a successful fundraiser. Also, all fundraisers must agree to them to become registered.

Applicant details

Title

First Name

Surname

Organisation

YesNo

Organisation name (if applicable)

ABN

Without spaces

Type of organisation

Please provide type of organisation

Date of Birth

DD/MM/YYYY

Street Address

Suburb

State

Postcode

Mobile

Work phone

Website

Are you completing this form on behalf of a person under the age of 18 years?

YesNo

Details of person under 18

First Name

If you are completing this form on behalf of a group of school students, please enter only one contact for the group.

Surname

Date of Birth

Do they live at your address?

YesNo

Street Address

Please tell us their address so we can thank them at the end of the fundraiser

Suburb

State

Postcode

Have you raised funds for The Royal Children's Hospital before?

NoYes

If so, when?

Proposal Details

Name of activity

Description of activity

Activity start date

Start time

Activity end date

End time

Venue name and address

Proposed ticket/entry price (if applicable)

Is your planned activity/event

Open to the publicBy invitation to family and friends

Do you have an external website, Facebook, Twitter or blog where you will advertise the activity?

NoYes

I'll be advertising on

WebsiteFacebookTwitterBlog

Website address

Facebook address

Twitter address

Blog address

How else do you plan on advertising the activity?

Do you intend to seek public liability insurance for your activity?

NoYes

Please provide insurance details

Has anyone involved in the activity had any connection with The Royal Children's Hospital?

Parent/Relative/Friend of patientPatient/past patientThis is the start of my relationship with The Royal Children's HospitalOther

Please provide details of other connections

Page 2

Financial Information

How will the funds be raised?

DonationsTicket salesSponsorshipSilent auctionLive auctionRaffleOnline fundraising pageCollection tinsSale of itemsOther (you will be asked to specify)

Other fundraising channels

Tell us how much money you think you will raise from each of these channels

Donation $

Ticket Sales $

Sponsorship $

Silent Auction $

Live auction $

Raffle $

Online page $

Collection tins $

Sale of items $

Other $

Total $

Will there be any expenses associated with running your fundraising activity?

NoYesPlease Note: proceeds from fundraising activities or donations cannot be used to cover activity.

Proposed Expenditure

VenueCateringAudio VisualPrinting (invites/tickets/posters)AdvertisingEntertainmentPrizesSupplies (decorations/gifts/stationery)SecurityInsuranceOther (you will be asked to specify)

Other Expenditure

Tell us how much expenditure you believe you will incur for each item

Venue $

Catering $

Audio Visual $

Printing $

Advertising $

Entertainment $

Prizes $

Supplies $

Security $

Insurance $

Other $

Total $

Estimate of funds raised for the RCH Foundation

Additional explanation regarding income and expenses (if required)

Funds raised

Will the RCH Foundation be the only beneficiary of the funds raised?

YesNo

If not, who are the other the beneficiaries and what will be the donation split?

Would you like to direct your funds to the area of greatest need in the hospital or to a specific department or cause?

For the hospital's most urgent needSpecific department/cause

Please specify the cause or department you would like the funds directed to

The information that I have provided is true and complete. I understand if my fundraising application is approved I will agree to the Terms and Conditions outlined in the Fundraising Guidelines.

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