Rescuer Award Nomination Form

Your Name (nominator)*:

Please enter a value.

Company Location/Virtual address*:

Please enter a value.

City/Town:

Please enter a value.

Province:

Please enter a value.

Postal Code:

Please enter a value.

Phone:

( ) -

Please enter a value.

Email:

Please enter a value.

Name of rescuer*:

Please enter a value.

Address of rescuer*:

Please enter a value.

Telephone of Rescuer*:

( ) -

Please enter a value.

Email of Rescuer*:

Please enter a value.

Date of rescue*:

Please enter a value.

Location of rescue*:

Please enter a value.

Details of rescue*:

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

Please enter a value.

Details of Rescue attachment:

Please enter a value.

Notes:

Please enter a value.

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

Please enter a value.

Interested in taking a Red Cross First Aid or CPR course? Find a course in your community or online.

You can purchase Red Cross First Aid kits, manuals and more!

Email Sign-up Now

The Canadian Red Cross takes your privacy seriously. View our privacy policy.