Jack Petchey ACHIEVEMENT AWARD Scheme Nomination Form

Quarterly award for achievement given to Werewolves of London players between the ages of 11-25

Period this Nomination is for *

Select the quarter this nomination is for

Name of person making the nomination *

This is your name

I nominate...... *

The player you are nominating. Must be between the age of 11-25

Their age *

Their age if known. If you don't know select the Not sure option.

I am a ............ at the club *

Select your relationship to the club

Player

Coach

Parent-Carer

Other:

Required

REASON FOR NOMINATION *

It need not be directly connected to the club, or to hockey – but perhaps to encourage someone who has been dealing with difficult circumstances , has changed their behaviour in a positive manner, or been supportive in some other way. Don’t vote just because someone is the coolest skater, or because they are your child or best friend – and remember that some of the players face greater challenges to meet targets than others.

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This form was created inside of Werewolves of London Special Hockey Team.