STARS AWARDS 2017
Nomination Form
I would like to nominate the following person
(you must obtain permission from the nominee before submitting the form)
STARS AWARDS 2017
Nominee
Title …………………………………………..
Name…………………………………………
Address …………………………………….
………………………………………………..
……………………………………………….…………………Postcode……………………
Email address………………………………...
Contact tel…………………………………….
DOB……………………………………………
Age(if under 16)…………………………….
Male/Female…………………………………
Nominee category
(please tick just one box)
□Child/Young Person
□Friend/Sibling
□Parent/Carer
Nominator
□ I am a nominator, here are my details
Title…………………………………………..
Name…………………………………………
Address…………………………………………………………………………………………………………………………………………………………………Postcode…………………
Email address……………………………….
Contact tel……………………………………
Age (if under 16)…………………………….
Job title……………………………………….
Organisation you represent………………..
………………………………………………..
Relationship to nominee…………………..
STARS AWARDS 2017
Publicity
□ I agree to publicity
□ I do not agree to publicity
□The nominee agrees to publicity
□ In the case of a child / young person under 16,I enclose a photo consent form signed by adult withparental responsibility of the nominee
□ The nominee does not agree to publicity
How and where did you hear
about the Stars Awards Scheme?
Which organisation/newspaper/publication?
………………………………………………..
What method? (please tick a box)
□In the Press
□By printed flyer
□By e-flyer
□By email
□Via a website
□By word of mouth
□Through membership of an organisation
(if so, which)
……………………………………………………
STARS AWARDS 2017
PLEASE BE AWARE INFORMATION FROM THIS FORM WILL BE USED AT THE EVENT TO PROVIDE THE SYNPOSIS ON THE NOMINEE.
Nomination Form
Please provide as much relevant information as possible in the space provided (no more than 200 words per question)
Please give brief background to nominee, details of condition, effect on everyday life
Describe what’s so special about the nominee’s achievements, eg. has the nominee demonstrated bravery, commitment, or has he/she inspired others in some way,?
What benefit or measurable impact has the nominee’s efforts had on the community, family, individual, and environment?
STARS AWARDS 2017
I confirm that to the best of my knowledge, all theinformation on this form is correct, that I understand andabide by all the terms and conditions.
Signature …………………………………………………………………………………………..
Date …………………………………………………………………………………………………
Photograph Consent Form
Name of parent/carer:Name of child:
Age of child:
Address:
Phone number/ email:
(PLEASE PRINT IN BLOCK CAPITALS)
The Children’s Foundation would like to take photographs of your child. These photographs will be distributed with press stories, published in our publications and/or on our external website (
Before taking photographs we need your permission. Please answer the questions below, then sign and date the form where indicated.
Please circle1.May we use your child’s photograph in printed publications? / YES / NO
2.May we use your child’s photograph on our website/social media? / YES / NO
3.May we use your child’s full name? / YES/ NO
Please note that our website can be viewed by anyone, worldwide.
This form is valid for four years from the date of signing. Renewed consent will be sought if the photographs are to be re-used after the expiry date.
Your Name: / (PLEASE PRINT)Signature:
Date: