Rescuer Award Nomination Form

Your Name (nominator)

Company Location/Virtual address

City/Town

Province or Territory

Postal Code

Phone (Optional)

Email

Name of rescuer

Address of rescuer

Telephone of rescuer

Email

Date of rescue

Location of rescue

Details of rescue

Please describe the rescue in the box above or provide a Word or PDF document attachment describing the rescue.

Upload details of rescue

Please select a file

Red Cross training (if applicable)

First Aid/CPR Babysitter First Responder Other

Other

Notes

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