Stollery Story Squad - Alumni Enrollment

Join the Squad - Alumni enrollment form

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* 1. Stollery alumni (18+)

Last name:

First name:

Birthdate:

Medical condition(s)/diagnosis:

Primary Stollery doctor(s):

Time spent in Hospital:

Surgeries/procedures:

Email:

Primary phone number:

Workplace (if you work outside your home):

Home address:

City:

Province:

Postal code:

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* 2. Stollery story:

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* 3. Please indicate which opportunities you’re interested in: (Please check all that apply)

External media (radio, TV, newspaper, etc.)

Public speaking (events, store visits, corporate meetings, etc.)

Stollery media (HEROES magazine, newsletters, online content, etc.)

Community engagement (Miracle Treat Day, parades, etc.)

All opportunities

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* 4. Do you have any other connections with the Stollery? (Please check all that apply)

My kid(s) are Stollery Superstars (youth fundraisers)

I'm a donor

I personally fundraise for the Stollery

I'm a volunteer (Stollery Women's Network, general volunteer)

I'm a Stollery Children's Hospital staff member

I work for a company that supports the Foundation:

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* 5. Expressed Consent to Email

In order for the Stollery Children’s Hospital Foundation to communicate with you via email and continue sending you electronic news and information pertaining to the Foundation and the Stollery Children’s Hospital, please provide your expressed consent below.

Yes

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* 6. Would you like to receive our monthly email newsletter, Bear Facts?

Yes

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* 1. Stollery alumni (18+)

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* 2. Stollery story:

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* 3. Please indicate which opportunities you’re interested in: (Please check all that apply)

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* 4. Do you have any other connections with the Stollery? (Please check all that apply)

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* 5. Expressed Consent to Email In order for the Stollery Children’s Hospital Foundation to communicate with you via email and continue sending you electronic news and information pertaining to the Foundation and the Stollery Children’s Hospital, please provide your expressed consent below.

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* 6. Would you like to receive our monthly email newsletter, Bear Facts?

* 5. Expressed Consent to Email

In order for the Stollery Children’s Hospital Foundation to communicate with you via email and continue sending you electronic news and information pertaining to the Foundation and the Stollery Children’s Hospital, please provide your expressed consent below.