OUTREACH ACTIVITY FORM
Thank you for reaching out to Kythe!
We would like to get to know you better and the information you will provide will help us determine the best opportunity we can offer you in partnering with Kythe.
Let's start!
 
What's your first name? *

 
And what's your last name? *

 
When is your birthday? *

 
Please let us know how to contact you.

 
And phone number? *

Also, the one you use frequently :)
 
Name of Company / Organization / Group *

If you will hold the activity as an individual / not with any group, please type "Individual".
 
How did you learn about Kythe? *

 
When do you plan to hold your activity?

Should be at least 2 weeks prior. Please provide 2 possible dates.
 
Activity date option 1: *

 
Activity date option 2: *

 
Preferred time of activity *


 
Proposed activity *

Ex. Magic show, gift-giving, kiddie party, out-of- hospital activity, etc.)
 
Preferred hospital *

Before choosing a hospital, it is best to read the guidelines by clicking on this link: www.kythe.org/hospital-guide

 
How many patients will you accommodate? *

Minimum of 30 patients plus 1 guardian each
 
Number of volunteers / guests going from your group: *

For infection control, please limit number of volunteers to 15.
 
Materials to be brought (for hospital activity): *

One item per line, please.
 
Before submitting this form, please take note of these guidelines and please confirm acceptance. *

1. A fee of P165.00 per participant (patient and guardians) will be collected for the following:
          - Meals for patients and guardian
          - Medical support for the patients  

Please deposit Kythe Foundation Inc. BDO 1158032499 or BPI Family Bank 6031 0529 02 – two weeks prior to the event. Email deposit receipt to info@kythe.org. This shall serve as confirmation of the event. This amount is non-refundable.  

2. Please text / call during office hours only (Monday - Friday, 8:00am to 4:00pm). Allow 2 weeks turn around time to arrange schedule.  

3. For out of hospital activities, kindly provide transportation allowance of P150 per patient (amount varies depending on the proximity of venue to the hospital);  

4. For photo ops, please ask permission first from the Child Life Coordinator (please take happy pictures only)   

5. We are also selling Kythe volunteer shirts at P300 each to support other Kythe programs :)
     
Thank you, {{answer_wkcEKteWm6mD}}! 
Our Kythe staff will contact you shortly.

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