Payroll Deduction

Every dollar makes a difference!


Your gift every pay period (two weeks)

Your total giving over a year











Cape Breton Regional Hospital Foundation Payroll Deduction Form


By supporting the Regional Hospital Foundation’s Payroll Deduction Program, you are helping purchase the equipment needed to provide the best care for the thousands of patients who rely on the Regional Hospital every year. Thank you for your continued support!


Please complete this form and return it by fax, mail or internal mail to:


Cape Breton Regional Hospital Foundation    or 

45 Weatherbee Road, Ste 209                                         Regional Hospital

Sydney, NS B1M 0A1                                                    2nd Floor

Fax (902) 567-7916An imageAn imageAn imageAn imageAn imageAn image                                                          



Email: ______________________________________________________

Address:                                                                   PC:_________

Phone Number: (h)                                                  (w) ____________________

Employee Number:                                                                                                         

Hospital Site: ________________________________________________



I am pleased to commit to the Employee Payroll Deduction Program.

The deduction amount shall be: ____________ each pay period.

Date of first deduction: ______________  Area of care:___________________________

Employee Signature: __________________________ Date: ________________


If you choose the Cape Breton Regional Hospital Foundation, please mark which designated area you would like your donation to go to:


Ambulatory Care

Area of Greatest Need

Cancer Patient Care Fund

Breton Cancer Centre

Coronary Care Unit

Diagnostic Imaging

Emergency Department

Geriatrics Services

Heart Lung Wellness Centre

Intensive Care Unit

Laboratory Medicine

Mental Health Units

Medical Surgical Inpatient Units

Mom and Baby (Obstetrics, Mom/Baby Clinic, Breastfeeding Clinic)

Neonatal Intensive Care Unit

Operating Room

Orthopedic Unit

Palliative Care Unit

Pediatrics Unit

Rehabilitation Services (Physiotherapy, Occupational Therapy)

Renal Dialysis Unit

Respiratory Services (Respiratory Therapy Dept., Chest Clinic)



**Important, please read: This deduction will continue until changed or cancelled by the employee through written notification to the Foundation which is in receipt of your donations.


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