Become a beneficiary – hearts-touch.com

Become our beneficiary…

First/Last Name *

First

Last

Phone number *

Email address *

Who needs help? *

Name of the person in need *

First

Last

Age of the person in need *

Place of residence of the person in need *

Postal code and city

Health condition *

Purpose of the fundraiser *

Amount needed for treatment *

Description of the fundraiser or link to an existing one *

Consents *

I have read and accept the terms and conditions available on the website hearts-touch.com

I consent to the public dissemination by the administrator of the website podarujserduszko.pl of images of my child or another person under my care.

I consent to the processing of personal data by the administrator of the website podarujserduszko.pl for the purposes specified in the privacy policy.