CAREGIVER NOMINATION FORM

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Heroes in the Home Caregiver Recognition Program
 
Thank you for nominating your Hero in the Home.

Eligibility Criteria:
  • Anyone can nominate an unpaid caregiver 
  • Caregivers are unpaid and either live within Hamilton, Burlington, Niagara, Haldimand Norfolk or Brant regions or provide support to a loved one who lives in Ontario – see map
  • The caregiver being recognized is not affiliated with a community service program e.g. hospital, hospice or visiting volunteer program
Important: Before completing the form, please make sure you have the correct contact information for the person you are nominating including their current address, telephone number and e-mail address. Please include as much information as possible about the person you are nominating and answer all of the questions. 

For more information about HNHB LHIN’s Heroes in the Home Caregiver Recognition program, please contact Janice Himes at 905-704-3288 or 1-800-810-0000 extension 3288.
 

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