Rescuer Award Nomination Form

Your Name (nominator):

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Company Location/Virtual address:

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City/Town:

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Province or Territory:

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Postal Code:

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Phone (Optional):

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Email:

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Name of rescuer:

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Address of rescuer:

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Telephone of rescuer:

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Email:

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Date of rescue:

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Location of rescue:

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Details of rescue:

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

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Upload details of rescue:

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Red Cross training (if applicable):

First Aid/CPR
Babysitter
First Responder
Other

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Other:

Notes:

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Please call the National Contact Centre at 1-877-356-3226 with any questions.

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