Nomination Form

Because every kid deserves a happy birthday!

Please submit this ONLINE NOMINATION FORM.

NOTE: The nominee must be a child who:
- lives in Essex or Union counties.

- is between the ages of 5 and 11

- the nominator believes is in economic hardship or family crisis

- has some special quality or circumstance that the nominator feels makes him/her deserving of a special party

Briefly explain why you would like to nominate this child to receive a spectacular party? Please read the criteria listed above this form. *

If this child is chosen to receive a party, how may we contact his/her parents/guardians? (names, phone numbers, email addresses, etc.) *

Name of Child's Town *

Child's Birthday *

Child's Grade in School

Age of Child (as of today) *

Name of Child You'd Like to Nominate: *

Your Phone # *

Your Name: *

Your Email: *

Your Position *

How long have you known the nominee? What is your relationship to him/her? *