Fundraising Application Form

Valley Children's Healthcare Foundation welcomes and encourages businesses, organizations and clubs to conduct fundraising activities on behalf of the children of Central California. Please review the Policies and Procedures for Fundraising Events before completing and submitting the form below to register your fundraising event.

If you would prefer to submit a completed application form to Valley Children's Healthcare Foundation in the mail, click here to download, complete and mail to:

Valley Children's Foundation
Attn: Community Events
9300 Valley Children's Place
Madera, CA 93636
Fax: (559) 353-7160

After we have received your application, we will contact you for proof of insurance and any additional follow-up information.

Organizer Information

Name of sponsoring organization/individual  *
Contact Person  *
Address  *
City  *
State  *
Zip  *
Home Phone 
Business Phone 
Email  *
Are you a grateful family of Valley Children's? 

Event Information

Event Name  *
Description of Event  *
Location(s)  *
Date(s) and Time(s)  *
Method of Raising Funds  *
Will you be advertising or publicizing this event? If yes, who will be in charge of doing so and what avenues will you use (radio, television, newspaper, other)?  *
Who is your target audience?  *

Financial Information (please estimate)

Estimated gift to Valley Children's 
Percentage of proceeds to Valley Children's 

Use of Funds

Please indicate where you want the donated funds to be used  *
If other, please specify 
Does the event benefit other organizations?  *
If yes, please specify 
Until written permission has been granted by the Foundation, contributions may not be solicited in the name of Valley Children's Healthcare and the name "Valley Children's Healthcare" may not be used for any purpose. 
I have read and agree to abide by the Special Events Policies and Procedures as set forth by Valley Children's Healthcare Foundation. The information provided on this form is correct and accurately describes the proposed event. 
Signature  *
Date  *