Hair Donor First Name*

Hair Donor Last Name*

Date of Birth*

Parent / Guardian First Name*

Parent / Guardian Last Name*

Email address*

Phone

Address*

Suburb*

State*

Postcode*

Date of Hair Cut*

Link to your Fundraising Page (If you have one, cut and paste the web page address )

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Your contribution*

$20 $20 will help meet urgent education expenses for a child with special needs
$50 $50 will give a child with a disability access to modified playground equipment
$100 $100 will help provide specialist medical equipment for a child with a rare disease
$250 $250 will give a child in need access to a specially modified bike

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Hair with Heart is a national campaign managed by the New South Wales office of Variety - the Children's Charity.

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Financial Donor First Name*

Financial Donor Last Name*

Financial Donor Email*

Receipt will be sent to this address

Bank account information

Please transfer your donation to the following account:

Bank: Westpac
Account name: Variety NSW
BSB: 032 020
Account number: 208569

Your donation will be processed as soon as it has been received. Once complete, we’ll send you a tax deductible receipt.

Cheque Information

Please make your cheque payable to:

Variety NSW
Locked Bag 2468
St Leonards NSW 2065

Your donation will be processed as soon as it has been received. Once complete, we’ll send you a tax deductible receipt.

By submitting this form, I agree to receive an email from Variety notifying me that the hair has been received. Information collected is in accordance with our Privacy Policy

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Hair Donors Form

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Cheque Information