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 )

How did you hear about us?*

Please provide details

Would you like to hear from Variety in your State?*

Sure do
No thank you

Would you like to make a donation?

Sure do!
No thank you

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

Payment Type*

Card
Bank
Cheque

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

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiry date CVC Cardholder Name

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

Payment Status

So that we can personalise your experience, please select your state.

Hair Donors Form

Bank account information

Cheque Information