Rescuer Award Nomination Form

Your Name (nominator)*:

Company Address*:

City/Town:

Province:

Postal Code:

Phone:

( ) -

Email Address:

Name of rescuer*:

Address of rescuer*:

Telephone of Rescuer*:

( ) -

Email of Rescuer*:

Date of rescue*:

Location of rescue*:

Details of rescue*:

Enter details here or attach a file in PDF or Word format illustrating the details of the rescue

Details of Rescue attachment:

Red Cross training (if applicable):

First Aid/CPR
Babysitter
Swimming & Water Safety
Lifeguarding
Other

Notes:

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