Shining Stars FUNdraiser Event Form

UnityPoint Clinic Urgent Care - Altoona

00 Patients
Waiting Now

UnityPoint Clinic Urgent Care - Ingersoll

02 Patients
Waiting Now

Urgent Care - Ankeny

08 Patients
Waiting Now

Urgent Care - Lakeview

03 Patients
Waiting Now

Urgent Care - Merle Hay

04 Patients
Waiting Now

Urgent Care - Southglen

06 Patients
Waiting Now

Urgent Care - Urbandale

01 Patients
Waiting Now

Virtual Care - Receive Care Now

X Wait Times

Shining Stars FUNdraiser Event Form

Thank you for being a Shining Star and planning a FUNdraiser for Blank Children's Hospital. Please complete the form below to let us know about your fundraising activity or event so we can help make it even more successful...and FUN!

FUNdraiser Event Form






Fundraiser Contact Name: Please check below for the Fundraiser Contact:
If 17 or younger, please complete the info below:Name of parent/guardian, teacher or youth activities director:Name of school or organization (if applicable):Email address:Phone number:

Address:
Fundraiser/Event Name:Date:Time:Fundraiser/Event Description:Inspiration for Giving to Blank Children's:Where would you like the funds raised to go? (Certain program, service or department at Blank Children's)Do you have any questions or need additional information?Click submit below when finished. Thank you!