Complete the following information to submit your nomination for a child who meets the requirements for a Hero Award.  We recognize that you may not know all of the requested details about the child, so please answer as completely as possible.

If the heroic act or deed was completed by a “group” of youth, please complete the form as best as possible and a staff member from the Safety Village will follow up with you for any further details required.

Nominator Information:

Candidate Information
(Please provide as much information as possible, based on the details available to you.)