A5 Celebration of Life leaflet form (PDF)

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Celebrate the life of a loved one by dedicating a
twinkling balloon to them this Christmas. Join us for
a very special balloon release as our twinkling lights
rise over Sunderland.

Friday December 11th 2015
6pm for a 6:30pm balloon release
at Sunderland Rugby Club

Charity number 1100682


This year we warmly invite you to
our Celebration of Life on Friday
11th December at Sunderland
Rugby Club, West Lawn,
Ashbrooke, SR2 7HH.
Dedicate a Christmas twinkling
balloon to celebrate the life and
love of someone dear to you. Then
join us and see it released into the
night sky.
There is no minimum donation – all
we ask is that you be as generous
as you can.
Our Celebration of Life will start at
6pm. Join us to sing Christmas
carols outside before the twinkling
balloons are released at 6:30pm.
Food and refreshments will be
available to purchase from the
Rugby Club.
For Health & Safety reasons, all balloons will be
held in a secure safety net prior to the launch.
As the release has to be synchronized with
local air traffic, it is not possible for all balloons
to be released individually.

Please complete the form using CAPITAL LETTERS. All forms need to be returned to us by noon on the
11th December 2015. If you require more than 5 balloons please attach a note to this form,
telephone 0191 525 2885 for an additional form or visit our website for more information.

1. I would like to dedicate a twinkling Balloon to:
First name: (balloon one)

Surname: (or other)

First name: (balloon two)

Surname: (or other)

First name: (balloon three)

Surname: (or other)

First name: (balloon four)

Surname: (or other)

First name: (balloon five)

Surname: (or other)

I would like to receive an acknowledgement containing all the names above
2. Please complete your personal details:
Name: Mr/Mrs/Ms/Other

Post Code:


Email address:
Are you coming along to our outdoor Christmas Carol Service, if so how many will be attending?

Yes how many?


3. Please enclose a donation for each balloon
I enclose a total donation of £ amount

Please make cheques payable to Grace House North East

To donate by credit/debit card please call 0191 525 2885 or complete the following:
Card number:
Card expiry date:

Card start date:
Security code: (last 3 digits)

4. Maximise the impact of your gifts by signing and dating the following statement if it
applies to you
I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April)
that is at least equal to the amount of tax that all the Charities or Community Amateur Sports Clubs (CASCs) that I
donate to, will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not
qualify. I understand the Charity will reclaim 25p of tax on every £1 that I give or have given in the past 4 years, until
further notice.



Please return this section together with your donation to:
Celebration of Life, Grace House, Bardolph Drive, Southwick, Sunderland SR5 2DE

who we are...
Grace House in Sunderland supports children and young people aged 5-18 years from all
over the North East who have complex disabilities, health needs and life limiting
We offer overnight specialist short breaks in our beautiful purpose built centre, which has
eight fully accessible bedrooms all with en-suite bathrooms. We are equipped with
specialist seating, sleeping and bathing equipment as well as monitoring systems in all
bedrooms to meet the needs of children with complex physical and health needs.
For fun, we have a sensory room and soft play area, music room and den, large gardens
where we grow our own fruit and veg, and lots of toys, games and technology to play with.
We aim to make a truly positive difference to the lives of disabled children and their
Children will come to Grace House and have the time of their lives and their families will
get to take a break and recharge their batteries.
With your support we can help around 100 families a year.

Bardolph Drive, Southwick, Sunderland SR5 2DE
Tel: 0191 5252885 Email: info@gracehouse.co.uk


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