Junior Super Heroes Nomination Form

We’re looking for 10 special kids who are battling illness, chronic pain and other health challenges to be part of a special project. The selected participants will receive; a custom-made superhero costume, a themed photoshoot and a giant poster of their photograph.

Additionally, their photograph will be featured in the upcoming 2020 Superheroes of Victoria Junior Supers calendar which will be sold with 100% of the proceeds going to the Help Fill A Dream Foundation.

To nominate someone you think would benefit from a once-in-a-lifetime superhero experience, simply complete the below nomination form.
Nominations should be for children between the ages of 5 and 16 and either living on or currently receiving treatment (or a support program) on Vancouver Island.
For those nominating a child on a family's behalf, we will need confirmation from the child's legal parent or guardian that consent is given for this nomination. 

If you have any questions on the project or how to complete this form, please contact us at contact@helpfilladream.com, or send a message on Facebook to Superheroes of Victoria here.

Deadline for nominations is June 30th, so reach out to us and tell us why your little one is a junior superhero.

**Keep in mind that the focus of this project is for this to be a positive experience for the child.
Please be sure to consider whether the child will be aware of and enjoy the process before completing this nomination.

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* 1. Is your little one a Superhero?

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* 2. Name of nominated child

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* 4. Is the child living or receiving treatment on Vancouver Island

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* 5. Please specify where on Vancouver Island you live or are receiving treatment

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* 6. Describe the child's condition and how it presents a significant challenge to day-to-day living.

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* 7. What method/mechanisms do you and/or the child use to manage this condition? What are their major support systems?
**example: music therapy, a service animal, outdoor activities, community programs, etc.

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* 8. What are the child's favorite activites? What makes them happy? :)

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* 9. What special features or personality traits make your child a superhero?
**example: advocates for their condition's foundation or program, brings joy to others, overcomes adversity, etc.

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* 10. If selected, will you be available for custom measurements/fittings (flexible timing), superhero photo day (Saturday August 31st), and the roll-out event (Saturday November 9th)?

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* 11. Feel free to submit a picture of your little superhero (optional).
Images can be sent to info@superheroesofvictoria.org. Please include the full name of the nominated child in your email.

Please note that these pictures WILL NOT be made public and are for the nomination review committee only.

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* 12. Provide us with both an email and phone number for the parent or guardian

While we believe that all children are superheroes and deserve the chance to be recognized, we are only able to select 10 nominations for this project. Nomination deadline is June 30th and a nomination review committee will convene to select the participants on July 7th.
All individuals submitting a nomination will be contacted within 1 week of the selection process.

Selected participants will be contacted by the project organizers to arrange for the following:
- measurements to be taken for costume creation
- collect bio information on the child
- be advised of the next steps and timeline of the project
Thank you all for sharing your stories with us and we look forward to hearing from you soon.
You're all superheroes in our eyes.
We respect the privacy of your child and your family and we will not publish or share any personal information as provided for the purpose of this application. Any personal information you provide is protected under the BC Freedom of Information and Protection of Privacy Act and all applications are kept confidential.

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