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Donations to Holland Hospital are used to support our community outreach programs. These programs bring health care services to at-risk individuals in our own community. One-hundred percent of your gift goes to the service(s) of your choice, with no deduction for administrative costs.
In the form below, please select the service you wish to support, or select the General Fund to have your gift divided between all four programs.
Contact Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Do you wish to remain anonymous?
Yes
No
Phone
Amount
*
$100
$50
$25
$
Donation Schedule
One Time
Monthly
Quarterly
Yearly
Community Outreach Program
Please pick the program you would like to support
select one
General Fund benefiting all programs
Breast Care Fund
Holland Community Health Center
Lights of Love
School Mental Health Program
School Nurse Program
Memorial/Tribute Gift
Memorial or Tribute
*
Please select one option.
select one
Memorial
Tribute
Not Applicable
Memorial or Tribute Gift Information
*
Please list the memorial or tribute honoree name and program (N/A if not applicable)
Send Acknowledgement to:
First Name
Last Name
Acknowledgement address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Add 3% to my total amount to help cover the payment processing fees
