Register an Event – Patient Family Engagement

"*" indicates required fields

Are you interested in hosting an event or creating a personal fundraising page to benefit UPMC Children’s Hospital of Pittsburgh? Please fill out and submit the registration form below. A representative from Children’s Hospital of Pittsburgh Foundation will then contact you within 3 to 5 business days to discuss your fundraising efforts.

If you have any questions, or if you are experiencing issues with this registration form, please contact the Foundation at 412-692-3900 or patientfamily@chp.edu.

Your Contact Information

First Name:*

Last Name:*

Organization Name:

Street Address:*

Street Address 2:

City:*

State*

Zip Code:*

Email*

Cell Phone:*

Alternate Phone:

Birthdate:*

I was/am a patient or patient family at Children’s Hospital.

Yes

FUNDRAISER INFORMATION

Do you plan to make an online fundraising page for your event?*

(A personal fundraising page can be customized and is a great way to collect donations! To view sample, please click here).

Area of Hospital to Support:*

Enter your own value

Anticipated Date of Your Fundraising Event:*

Description of Your Fundraiser:*

What is your fundraising (financial) goal?

Can we feature your fundraiser on our website, email, or social media?*

WAIVER ACKNOWLEDGMENT

Guidelines, Terms and Conditions

I have read the Guidelines, Terms and Conditions.

Yes, I agree to the Guidelines, Terms and Conditions.*

Yes, I agree to the Guidelines, Terms and Conditions.

Terms of Use

I have read the Terms of Use.

Yes, I agree to the Terms of Use.

User Agreement

I have read the User Agreement.

Yes, I agree to the terms of the User Agreement.*

Yes, I agree to the terms of the User Agreement.

Phone

This field is for validation purposes and should be left unchanged.