Duke Children's Community Partner Registration

Thank you for your interest in hosting a community event or fundraising activity to benefit Duke Children’s! Please complete this form and a representative from Duke Children’s Development will contact you as soon as possible. For questions about this process, please contact us at 919-385-0033 or julie.watson@duke.edu. Duke Children’s Development must approve all Community Partner activities. You will receive notification of the status of your application.

Name of Event/Activity*

Nature of Event/Activity*

Please explain in detail.

Has this event/activity been done before?*

Yes

When was the last event?

Location of Event/Activity*

Is your event location indoor or outdoor?

Indoor

Outdoor

Date of Event/Activity*

Atlernate Date

In the case of rain or other obstacle.

Projected Attedance

Will any other organization benefit from this event/activity? If so, please name and describe the extent to which they will benefit.

List of businesses you intend to ask to sponsor this event/activity.

Please tell us why you chose Duke Children’s as your charity.

Sponsor Information

Please provide the contact information for the sponsor or host of the event/activity.

Name of Sponsor

Number of years in existence

Number of employees/members

Previous relationship with Duke Children's

Address

Contact person's name*

Email*

Phone Number*

Funds

We require that at least 50 percent of the net proceeds be directed to Duke Children’s; exceptions may be made on a case-by-case basis.

Projected Costs

Projected Income

Estimated Donation

Expected dated net proceeds will be donated to Duke Children's

How will proceeds from the event be given to Duke Children's?

NOTE: If you choose to offer the option for online credit card giving, please direct donors to giving.dukechildrens.org. Online gifts must be made directly to Duke, rather than filtered through another source (i.e., PayPal) to ensure that the gift is credited to the individual donor, and a tax receipt can be issued. A unique URL for online giving to your event/activity may be coordinated once your event/activity is approved. Donations made to an event/activity through PayPal and then forwarded to Duke are credited as a lump sum to "various donors." Because Duke cannot verify the individual payments/amounts, no tax receipts can be provided.

Cash

Check

Online Giving

Other

Marketing & Communications

Please review the Marketing and Communications Policies (https://www.dukehealth.org/sites/default/files/duke_childrens_third_party_communications_policy_05_final.pdf) in the Community Partners Event & Activity Guidelines. Duke Children’s Development Office must review all materials that include our logo and/or name. Materials must be submitted at least 30 days in advance to lindsay.gordon@duke.edu for review and approval prior to distribution to any third party.

Speaker requested from Duke Children's (if desired)

Other support requested

Please describe the types of promotions you plan to use for your event.

Acceptance and Signature

I/we have read the Community Partners Event & Activity Guidelines in full, and I/we agree to adhere to those guidelines in planning and executing our event/activity. I/we understand that the guidelines are not comprehensive and that all decisions for the event/activity, including safety precautions, remain the responsibility of the event/activity sponsor. Duke Children’s and its affiliates, including Duke University Health System, do not accept or assume any liability associated with event/activity. I/we shall indemnify, protect, defend and hold harmless Duke Children’s and its affiliates, including Duke University Health System, and their officers, directors, employees, agents, affiliates, and contractors from and against any and all claims, liabilities, damages, losses, demands, suits and judgments, interest, and expenses, including without limitation reasonable attorneys’ fees and costs, arising from or relating to our event/activity.

I have read the policies contained in the Community Partners Event & Activity Guidelines.*

https://www.dukehealth.org/sites/default/files/duke_childrens_third_party_communications_policy_05_final.pdf

Signature*

Type name of signatory.

Send me a copy of my responses

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