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Roseland Children's Health Center
[contact us]

[mother and daughter]
Thank you for your interest in the Roseland Children's Health Center. We depend on donations and volunteers to help us continue to provide high quality, low cost health care. If you are interested in receiving more information about the Health Center or learning more about how you can help, please complete the following form. Thank you again.

Rest assurred, any information you provide will be kept in strict confidence. If you indicate, we will place you on our mailing list and/or be contacting you at your convenience to discuss helping the clinic.

Name:
Address:

Phone (home):   Phone (work):
Best time to call:
  • Day
  • Evening
  • Either
   Best time to call:
  • Day
  • Evening
  • Either

Interests (check all thay apply):

  • I would like to be on your mailing list
  • I would like to help with fundraising
  • I would like to help as a volunteer at the clinic
  • I would like to become a sponsor with a donation of:
    $ (specify amount). Please make check payable to:

Roseland Children's Health Center

and mail to:

SCPEO
555 Sebastopol Road
Santa Rosa, Calif. 95407
(707) 578-2005