Labour of Love Plaque Order Form

Honour the birth of a new baby or special occasion with a commemorative plaque.

A minimum contribution of $200 is requested for each plaque. (Privacy Statement)

If you have any questions, please contact our office at 416-586-4800 ext. 8290 during our regular business hours, Monday to Friday, 9:00 a.m. to 5:00 p.m.

Please complete the following information.  When you are finished, click on the "Proceed to next step" button.

Mount Sinai Hospital provides secure payment via

Billing Information

Your Name (Required)

Address (Required)

Suite, Unit, or Apartment

City (Required)

Province / State (Required)

Postal / Zip Code (Required)

Telephone (Home)

Please include area and/or country code as applicable

Telephone (Business)

Please include area and/or country code as applicable

Your E-Mail Address (Required)

Plaque Information

Name on Plaque (Required)

Date of Birth / Occasion (Required)

-- 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 / -- January February March April May June July August September October November December / -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Acknowledgment Information

(Where to send the acknowledgment?)

Name (Required)

Address (Required)

Suite, Unit, or Apartment

City (Required)

Province / State (Required)

Postal / Zip Code (Required)

How would you like the recipient acknowledgment to be signed? (Required)

Secure Online Payments

Mount Sinai Hospital has provided the opportunity to use PayPal for online payments.  As an entity independent of Mount Sinai Hospital, PayPal has a reputation for safely collecting payments using your credit card details or a PayPal account. Mount Sinai Hospital does not have access to, or use of, your credit card or Paypal account details. 

PayPal is a trusted leader in online payments, enables buyers and businesses to send and receive money online. PayPal has over 96 million member accounts in 55 countries and regions. For more information, please visit PayPal’s Website.

Please allow 6-8 weeks for the plaque to be mounted on the Labour of Love Wall on the 10th floor maternity ward.

Charitable Registration Number: BN 11904 8122 RR0001

A tax receipt for income tax purposes will be issued.