Payday Payout Enrolment Form

YES, I want to support the We Care Special Grant Program!

First Name:(Required)
Last Name:(Required)
Department:(Required)
Email:(Required)
Phone:(Required)
Extension at work:
I understand that:(Required)
- That the prize board will be $1,000 every payday and a minimum of 400 employees must participate at all times in order to sustain the lottery;
- I can stop participating in the lottery at any time by giving thirty days’ (30) written notice to the Foundation ([email protected]);
- If I withdraw from the lottery, I am not permitted to re-sign for one full year.
- I hereby authorize Guelph General Hospital to deduct five dollars ($5) from my pay cheque every two weeks to be given to The Foundation of Guelph General Hospital for fundraising by means of an Employee Lottery.