COVID-19 Staff Support Via Payroll Deduction Authorization To provide support through Children’s Help Fund to employees impacted by COVID-19. Gifts can also be made via credit card here. I authorize Children’s Hospital & Medical Center to deduct the following amount: Please enter flat dollar amount. Donations authorized April 1-12 will be deducted on your April 17 paycheck. Donations authorized April 13-19 will be deducted on your May 1 paycheck. Donations authorized April 20-30 will be deducted on your May 15 paycheck. Employee Name First Last Employee ID Number Department Work Phone Extension Email Signature Please type your name in the signature field. Please check the box below:
