Donor Questionnaire

Here at the Janeway Children’s Hospital Foundation we value your ideas and opinions. This survey will help us to provide you with information that you are most interested in. Please rest assured that any information you share with us will be kept in the strictest of confidence.

Where does the Janeway Children’s Hospital Foundation fall within your charitable giving plans?
- The Number #1 Charity that I support
- Included in the top 2 charities that I support
- Included in the top 5 charities that I support
How long ago was your first donation to the Janeway Children’s Hospital Foundation?
- Less than five years ago
- Five to 10 years ago
- 10 – 20 years ago
- More than 20 years ago
Over the past five years, what is the largest single donation you have made to a charity?
- Less than $100
- $100 - $249
- $249 - $499
- $499 and Over
Why do you support the Janeway Children’s Health and Rehabilitation Centre by donating to the Janeway Children’s Hospital Foundation?
- I am/ was a patient
- A member of my family is/ was a patient
- A family friend is/ was a patient
- Supporting the health care of our province’s children is a priority for me/ my family
If you were to choose, what funding areas within the Janeway Children’s Health and Rehabilitation Centre would most interest you?
- Area of greatest need
- Medical equipment needs of the Hospital
- Pediatric Research
- Staff Education/ Bursaries
- Capital Campaign
Would you be interested to learn more about the Janeway Children’s Health and Rehabilitation Centre and the Janeway Children’s Hospital Foundation?
- I would be interested in receiving print materials (brochures, newsletters, etc.)
- I would be interested in taking part in a Hospital Tour
More than one million Canadians have made the generous decision to include a gift in their Will to support their favourite charities. Are you familiar with this type of charitable giving?
- I am familiar with this type of gift option
- I have heard about making a gift in my Will, but I do not know much about this option
- I am not familiar with this type of gift option
Are you aware that leaving a gift in your Will, may help in reducing the taxes that your Estate will have to pay?
- Yes
- No
Have you ever considered making a gift, in your Will, to support the Janeway Children’s Hospital Foundation?
- I have made a charitable gift, in my Will, to the Janeway Children’s Hospital Foundation
- I intend to make a gift, in my Will, to the Janeway Children’s Hospital Foundation
- I am considering a gift, in my Will, to the Janeway Children’s Hospital Foundation
- I do not plan to make a gift, in my Will, to the Janeway Children’s Hospital Foundation
Would you visit a charity’s website to find out information about arranging a gift in your Will?
- I have already looked for this information online
- I would likely look for this information online
- It is not likely that I would look for this information online
- I do not visit charity websites
Would you like to receive information about arranging a gift in your Will to the Janeway Children’s Hospital Foundation?
- Yes, I would like to receive information about arranging a gift in my Will
- No, I am not currently interested in receiving information about arranging a gift in my Will
The following information will help us to get to know you better. We realize that these are very personal questions and we certainly understand if you do not wish to complete this section of the survey.
Gender
- Male
- Female
Marital Status
- Single
- Married
- Common Law
- Divorced
- Widowed
Age
- 65 and Over
- 45 – 64
- 30 – 44
- 29 and Under
Specific Question(s)
- Yes, I would like to have someone from the Janeway Children’s Hospital Foundation contact me to answer my specific question(s).
- No, I do not have any specific question(s) at this time.
To ensure that we are able to provide you with the information you wish to receive, please complete the following contact information.
Name*
First Last
Home Phone*
Work/Cell Phone
Email*
Address
Street Address City Province Postal Code
Additional Comments

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Donor Questionnaire

Explore our website!

To pledge your support, donate now!

Explore
our website!

To pledge your support,
donate now!