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Be A Hero To A Little Champion - Fall 2018
The Children’s Hospital of Michigan Foundation has partnered with the Detroit Red Wings to offer a Little Champion the opportunity to attend a Detroit Red Wings Hockey Game.
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Email
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Your email
Your Name
First Name
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Your answer
Last Name
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Your answer
Your Contact Info
Phone Number
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Your answer
How did you hear about the Little Champion Program?
Radio
Social Media
CHM Foundation Website
Other:
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Nominee
First Name
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Your answer
Last Name
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Your answer
Street Address
Your answer
Street Address 2
Your answer
City
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Your answer
State
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Your answer
Zip Code
Your answer
Age of Nominee
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Your answer
Your Relationship to Nominee
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Mother
Father
Aunt
Uncle
Sister
Brother
Grandmother
Grandfather
Godparent
Friend/Friend of the Family
Name of Parent or Guardian
First Name
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Your answer
Last Name
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Your answer
Phone Number of Parent or Guardian
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Your answer
About Nominee
In 100 words or less, explain why you are nominating this child to be a Little Champion of the Game. What challenge(s) did they overcome?
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Your answer
Submit Form
By checking the box below, I understand that my nomination is complete once I submit a photo to to the following email address:
whitney.white@chmfoundation.org
. All submissions without a corresponding photo are incomplete and will not be considered. Please email photo with Nominee's first and last name as the subject line.
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I will submit a photo to the above email address to complete my nomination.
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