Online Donation Form

Please complete the form below. You will be prompted for your payment information on the next page.

Your Donation

Donation Amount (CAD) $

Pay by Credit Card

Pay with INTERAC^© Online

Recurring Payments:

Please call Jessica at the Niagara Peninsula Children's Centre at 905-688-3550 (x247) to set up a recurring payment.

Your Name & Address

E-Mail (required)

Your name (required)

Address Line 1 (required)

Address Line 2

City (required)

Province (required)

Country

Postal Code (required)

Special Notes

You will enter your credit card information and
confirm your transaction on the next page.

Admeris Payment Systems

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Delivery method and timing: NA — donation
Products / Services & Pricing: NA — donation
Refund Policy: please note that as the funds received are donations, there will be no refunds. However an income tax receipt will be provided for your records.