Donation Form

Text Box:
PRINT THIS PAGE & MAIL WITH GIFT TO:

      Children’s Shelter of Blackstone Valley
     15 Gates Street
      Pawtucket, RI 02861

Your Name:________________________________

Address:___________________________________

City/State/Zip: ______________________________

   If you would like this donation to be a tribute,
please provide the acknowledgement information below:

           _____ In Honor of                       ___ In Memory of

Name of individual: ____________________________________

Address:_____________________________________________

   City/State/Zip:________________________________________

   Occasion: ____________________________________________

Amount: _____________

   Thank you for your contribution. All donations are tax-
   deductible as provided by law; we are a 501 (c) (3) Corporation.

Please be sure to check with your employer; many companies
   will match charitable contributions made by their employees.

Your donation will directly benefit the children.

Text Box:                                                    To contact us:
                                       Phone 401 722 4626
                                       FAX 401 727 2967
                                       Email: childrensshelter@cox.net