Donate

Thank you for supporting Base School ’s Annual X! We will receive a substantial profit from every donation and these funds will be used to benefit all of our students Please know that your student, teacher and entire school appreciate your generous gift!

Please fill out the following form to donate toward your student by February 5, 2019.

You may give a flat amount or a per lap amount (after your student has completed their run).  We will not automatically populate laps for per lap donations.  You will need to let any donors know your student’s total after the Run.

We are asking for all donations to be made online.  If you have to send a check or cash, it must be turned in by your student on February 5, 2019. Please make checks out to Example Elementary PTO.

Donor First Name *

Donor Last Name *

Donor Email Address *

Donor Mobile Number *

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First Student Donation Details

Please make sure to enter Student information below so your donation will be credited correctly.

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Student First Name *

Student Last Name *

Donor Relationship to Student * FatherMotherBrotherSisterUncleAuntGrandparentOther

Grade * PKK12345678otherunknown

Type of Donation * Flat DonationDonation Per Lap

Flat Donation Amount ($) *

Number of Laps Run *

Amount per Lap ($) *

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Do you wish to donate for a second student? * YesNo

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Second Student Donation Details

Please make sure to enter Student information below so your donation will be credited correctly.

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Student First Name *

Student Last Name *

Donor Relationship to Student * FatherMotherBrotherSisterUncleAuntGrandparentOther

Grade * PKK12345678otherunknown

Type of Donation * Flat DonationDonation Per Lap

Flat Donation Amount ($) *

Number of Laps Run *

Amount per Lap ($) *

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Do you wish to donate for a third student? * YesNo

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Third Student Donation Details

Please make sure to enter Student information below so your donation will be credited correctly.

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Student First Name *

Student Last Name *

Donor Relationship to Student * FatherMotherBrotherSisterUncleAuntGrandparentOther

Grade * PKK12345678otherunknown

Type of Donation * Flat DonationDonation Per Lap

Flat Donation Amount ($) *

Number of Laps Run *

Amount per Lap ($) *

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Do you wish to donate for a fourth student? * YesNo

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Fourth Student Donation Details

Please make sure to enter Student information below so your donation will be credited correctly.

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Student First Name

Student Last Name

Donor Relationship to Student FatherMotherBrotherSisterUncleAuntGrandparentOther

Grade * PKK12345678otherunknown

Type of Donation * Flat DonationDonation Per Lap

Flat Donation Amount ($)

Number of Laps Run

Amount per Lap ($)

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Do you wish to donate for a fifth student? * YesNo

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Fifth Student Donation Details

Please make sure to enter Student information below so your donation will be credited correctly.

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Student First Name

Student Last Name

Donor Relationship to Student FatherMotherBrotherSisterUncleAuntGrandparentOther

Grade * PKK12345678otherunknown

Type of Donation * Flat DonationDonation Per Lap

Flat Donation Amount ($)

Number of Laps Run

Amount per Lap ($)

Would you like to donate towards covering the fees to the school? Our suggested amount would be 7.5%. 100% of this amount goes to your school and will not count towards any prizes or fundraising goals. *

YesNo

% of your total $0

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Sub Total for First Student :

$ 00.00

Sub Total for second Student :

$ 00.00

Sub Total for Third Student :

$ 00.00

Sub Total for Fourth Student :

$ 00.00

Sub Total for Fifth Student :

$ 00.00

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Total Donation Amount: Donation for school fees: Transaction Fee: Total:

$00.00 $0.00 $0.20 $1.75

(Transaction fee is charged on a per credit card transaction basis)

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Donor Address *

Donor State/ Province Select Province/StateAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward islandQuebecSaskatchewanYukon====================AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Donor City

Donor Postal Code *

Donor Country * United StateCanada

Name on Card * Credit card number *

Exp Year *

CVV *

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