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 DONATION FORM Please print and complete the form below and mail to: Durham Christian Homes Society Inc. 200 Glen Hill Drive South Whitby, ON L1N 9W2 Our DCH Family of Homes enrich the lives of the residents we serve and those who serve them in seniors’ housing, assisted living and long‐term care. Donations may be used to purchase equipment or to enhance programming and services that directly impact the quality of care for our residents. Please accept my donation of † $25 † $55 † $100 † $200 † $300 † $500 † $ _____________ † CHEQUE ‐ Cheques should be made payable to one of: Providence Place Christian Homes, Tekoa Manor Christian Homes or Glen Hill Terrace Residence depending on the designation you select below. † CASH Name of Donor (receipts will be issued for donations over $25): Name: __________________________________________________________________________________ Address: _______________________________________________________________________________ ________________________________________________ Postal Code: ___________________________ Please designate my donation to the following community: † Providence Place † Tekoa Manor † Glen Hill Terrace COMMEMORATIVE GIFTS – IN MEMORY or IN HONOUR Please print and complete the form below and mail to: Durham Christian Homes Society Inc. 200 Glen Hill Drive South Whitby, ON L1N 9W2 Our DCH Family of Homes enrich the lives of the residents we serve and those who serve them in seniors’ housing, assisted living and long‐term care. Donations may be used to purchase equipment or to enhance programming and services that directly impact the quality of care for our residents. † CHEQUE ‐ Cheques should be made payable to one of: Providence Place Christian Homes, Tekoa Manor Christian Homes or Glen Hill Terrace Residence depending on the designation you select below.) † CASH This gift is: † In Memory of ___________________________________________________________________ † In Honour of ______________________________________________ † Anniversary † Birthday Name of Donor (receipts will be issued for donations over $25): Name: _____________________________________________________________________________________ Address: ___________________________________________________________________________________ _____________________________________________________ Postal Code: ___________________________ Send an acknowledgement card to (donation amount will not be shared): Name: _____________________________________________________________________________________ Address: ___________________________________________________________________________________ ______________________________________________________ Postal Code: __________________________ Message in card: _____________________________________________________________________________ ___________________________________________________________________________________________ Please designate my donation to the following community: † Providence Place † Tekoa Manor † Glen Hill Terrace