Nominate

Name*

Date of birth *

Helps to care for a parent or siblingHas been part of a family bereavementYoung person who has been a victim of crime, been traumatised as a crime witness or has been a victim or serious bullying or hate crimeYoung person who has displayed exemplary good behaviour, or bravery, to the benefit of their school, community or society in general

PLEASE EXPLAIN WHY THE ABOVE HAS BEEN PUT FORWARD FOR A FREE HOLIDAY AT JAMES BULGER HOUSE*

Do you have any independent or media evidence newsletter or website cuttings to support this nomination? You may be asked to show the evidence before the award is made.*

YesNo

Is the candidate, and/or his/her parents or guardian aware that you are nominating them for this holiday award? *

YesNo

Have you established that, subject to availability, the nominee and their family, will be able to take up the offer of a holiday?*

YesNo

You warrant that the information submitted in this form is, to the best of your knowledge accurate and true.*

Yes

Your name *

Your date of birth *

Your email address*

The nominee or family will need to pay the deposit of £250 in full before the family can stay at the James Bulger House. The deposit will be returned within 14 days, once the lodge has been checked to see if it has been left clean and tidy, that nothing has been taken or damaged, failure to do so will result in part or all of the deposit to be used to put right.*

I/we understand that the deposit will be used to clean or replace any broken items at the James Bulger House, I/we understand that James Bulger House has external and internal cctv which is on record at all times and can be monitored.

No Pets Allowed