Buy-A-Day Form



Please print and complete the following form and return it with your check to:

Welcome HOME
4260 W. Hawthorne Drive,
West Bend, WI  53090



YES, I’d like to BUY-A-DAY



Email: _____________________________________

Address: _____________________________________

City: _________________________________    State:  ____    Zip: _________

I’d like to sponsor these dates: (mm/dd/year) 


This date is significant to me because:


If you are purchasing a day for someone else, we will be glad to notify him / her of your gift.

Please provide the following information:
Their Name:  _____________________________________

Their Address: _____________________________________

Their City: ____________________________     State: ____     Zip: _________

Their E-mail: _____________________________________

For each day you sponsor Welcome, HOME will:

  • Mail you a thank you and tax deduction receipt for your donation
  • Post daily sponsors on the Welcome, HOME bulletin board
  • Send a note telling you about your day at Welcome, HOME



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Enriching the lives of people living with disability.