Just for J Holiday Nomination Form
We are always accepting nominations for a Just for J family to bless during the holidays. If the child you have nominated is selected by our committee, you and the honorary family will be contacted!

Just for J raises awareness for Charcot Marie Tooth Disease while giving back to children faced with medical challenges. Just for J strives to provide necessary equipment and/or opportunities to fulfill dreams that otherwise may not be possible.

Requirements:
The child with medical needs must be under the age of 18
Child has ANY medical challenge that impacts their life

Please feel free to read more about our past recipients and their stories located on our website. For more information regarding nominations, please contact info@justforj.com. We would LOVE to hear from you.

Just for J Chapter Closest to You? *
Child's Name *
Your answer
Child's Age *
Your answer
Child's Medical Challenge *
Your answer
Child's Parent Name *
Your answer
Child's Parent Phone Number *
Your answer
Child's Parent Email Address *
Your answer
Why are you nominating this child for Just for J? *
Your answer
How do you know this child? *
Your answer
How will this child benefit from receiving funds from Just for J? *
Your answer
Does this child have another page (Facebook, Go Fund Me, YouTube video, etc.) that we can get more information from? If so, please provide here! *
Your answer
How did you hear about Just for J? *
Your answer
Nominator's Name *
Your answer
Nominator's Phone Number *
Your answer
Nominator's Email *
Your answer
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