Nominate Details of the child you would like to nominate. Name (required)* First Name Last Name Date of birth * DD MM YYYY Address* Street Address Address Line 2 City ZIP / Postal Code Category* 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* (Tell us in no more than 300 words, what happened to the candidate – or about the good conduct or bravery that they have displayed.) 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 details Your name (required)* First Name Last Name Your date of birth * DD MM YYYY Your email address* Enter Email Confirm Email
