A Star Is Born

To mark the beginning of a new life and leave a legacy for your child born at West Lincoln Memorial Hospital, donate today.

Your support will commemorate the birth of your new bundle of joy and support the current equipment needs of West Lincoln Memorial Hospital. A one-time donation of $50 will secure a spot on the A Star is Born Hall of Fame wall!

Donation Package Includes:

Your child’s name, birth date and weight will be displayed on the new A Star is Born Hall of Fame Recognition Wall located in the Maternal Health department of the hospital. A complementary, professional in-studio 30 minute photo session with Reflections will take place within the first 2 weeks of birth.

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Donation Form

Donor Name
Name*
First Last
Newborn Information
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Gender*
Birth Weight*
Parent Information for Notification
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City Province Postal Code
Miscellaneous
Additional Comments
Consent*
I agree
I hereby consent that the photographs taken and presented by the photographer may be used by West Lincoln Memorial Hospital Foundation Inc. for the purpose of display, portfolio, promotion, for use on its website, newspapers, or any other publications.

Confidentiality

I understand that West Lincoln Memorial Hospital Foundation Inc. will keep my donation information I provided here confidential and agree that the Foundation may forward information or requests for donations in the future.