Jr. Captain Nomination Form
Nominate a child between the ages of 7-16
that best represents the services your
Non-Profit organization provides
(One candidate per Broward County non-profit may be nominated with the exception of twins)
ALL SUBMISSIONS FOR NOMINATION MUST INCLUDE:
Contact: _____________________________________________Title: _________________________
Phone: ________________________ Email: _______________________________________________
NAME: _______________________________________ AGE:_________ (between the ages of 7-16)
Parent/Legal Guardian Name: _________________________ Cell Phone: _______________
Attach to nomination submission:
- CHILD’S STORY (max. of 250 words)
- LETTER of CONSENT for nomination from the Parent/Legal Guardian
EMAIL nomination to:
firstname.lastname@example.org – Subject line: Jr. Captain (Non Profit Name)
NOMINATIONS ARE NOW BEING ACCEPTED
The Non-Profit Organization will be emailed once the Nominee has been accepted. This is a social media contest using multiple platforms such as Facebook and Twitter during the month of September.
PLEASE SUBMIT FORMS / PHOTO BY AUGUST 30th.
One lucky winner will be selected via the most votes on Social Media.
EXAMPLE OF A PARENT CONSENT FORM:
I do hereby consent that , ____________________________________ (child’s name) a minor, be allowed to participate in the 2016 Winterfest Jr. Captain Contest with his/her photo, name and association with (name of charity) to be used for voting/contest promotional purposes.
Signature of Parent or Legal Guardian Print Name
PAST JR. PARADE CAPTAINS:
2016: Daniel Moreno representing the Ann Storck Center
2015: Madison Smith representing Cure SMA – Spinal Muscular Atrophy (SMA) type 2
2014: Alex Casamento representing the Arthritis Foundation, Florida Chapter, SE Region. He was diagnosed with Juvenile Idiopathic Arthritis (JIA) at the age of five and is one of 300,000 kids in the U.S. who suffers from this painful and incurable disease.
2013: Lauren Bendesky who was diagnosed with Stage IV Neuroblastoma. Her fight and optimistic attitude is the reason “A Prom to Remember” nominated as their representative in the Parade. Lauren was aboard the Jr. Captain Showboat powered by FPL
2012: Sydney Lister diagnosed with a rare and aggressive form of bone cancer called Ewing’s Sarcoma (Facebook winner with 927 votes).
2011: Five year old Martina Bello diagnosed with Leukemia sponsored by the James Jr. Fund.
2010: Alison Marchessault – Born with the Recessive form of Polycystic Kidney Disease, Alison Marchessault has spent so much of her life in hospitals. She is an extremely bright, beautiful and happy young woman. Starlight Children’s Foundation has been one of Alison’s favorite organizations over the years and she participated in the parade on the Florida Marlin’s Boat highlighted this charity.
2009: TheWinterfest® Jr. Captain was created as a legacy of 15-year-old Amanda Blake who battled osteosarcoma, a rare form of bone cancer.