CHECT Champion nomination form
I would like to nominate? (full name) *
Your full name? *
Your relationship to the child? *
Phone number? *
Email address? *
Name of parent/carer of nominated child? (if different from above)
Date of birth of nominated child? *
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Address of nominated child? *
Please tell us, in as much detail as possible, why you would like to nominate a child for this award. Please tell us what has made you most proud, what they enjoy, or anything else specific that you would like to include. (The information you provide will help us form part of your child's nomination speech)
If you would like a photo of the nominated child on the certificate then upload below:
If you, or your nominated child, are happy to be involved in raising awareness of Rb by sharing your story with the media please tick here.
By ticking the box below you are agreeing to the terms and conditions outlined on our website.
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