Required fields are marked with asterisks (*)

Region of Waterloo Donation in support of the Children and Youth Planning Table

Visit the Children and Youth Planning Table (CYPT) website for more information on the CYPT: https://childrenandyouthplanningtable.ca

Thank you for your generous gift to the Children and Youth Planning Table. We are grateful for your support which will help us continue to collaborate with our members as we work to realizing our vision: Happy, healthy children and youth-today and tomorrow.

First Name:

Middle Initial:

Last Name:

Address: (Street, Apt. No., P.O. Box, R.R. No.)

City/Town:

Province:

Postal Code:

Country:

Phone number:

Email:

Donation Amount

$25

$50

$100

$500

Other

By continuing I confirm:

i) I understand that The Regional Municipality of Waterloo (the "Region") retains unconditional and complete ownership of the funds donated and/or items purchased with donated funds, and that I retain no ownership in such property.

ii) I understand that the Region's staff will use their best judgment about how this donation may best be used, and that I do not expect to be informed of their decision or have any control over such decision.

iii) The Region shall not be liable in any way to the donor for any damage, loss or injury of any nature whatsoever, or any costs or expenses that may be incurred because of any such damage, loss or injury, that may occur in the furtherance of the administration of the donation.

Personal information requested on this form is collected under the authority of the Municipal Act and will be used to maintain a record of the funds donated to the Department of Planning, Development and Legislative Services. Questions regarding this collection should be forwarded to the Manager, Region of Waterloo Children & Youth Planning Table, Planning, Development and Legislative Services, at 99 Regina St. S., Waterloo, N2J 4G6. 519-575-4400.

City of Cambridge

City of Kitchener

City of Waterloo

Township of North Dumfries

Township of Wellesley

Township of Wilmot

Township of Woolwich