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.
Email address *
Your Name
First Name *
Your answer
Last Name *
Your answer
Your Contact Info
Phone Number *
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How did you hear about the Little Champion Program?
Nominee
First Name *
Your answer
Last Name *
Your answer
Street Address
Your answer
Street Address 2
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City *
Your answer
State *
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Zip Code
Your answer
Age of Nominee *
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Your Relationship to Nominee *
Name of Parent or Guardian
First Name *
Your answer
Last Name *
Your answer
Phone Number of Parent or Guardian *
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? *
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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