and ensure all spelling and details are correct.
CHILD’S NAME ________________________________________________________
FIRST NAME SURNAME
ADDRESS ___________________________________________________________
POSTCODE _____________
Please Tick the following 2 boxes to enable your child to be nominated
for the Children of Courage Award for 2019.
As the parent / guardian of the above child, I give my permission for the child to be
nominated for a Children of Courage Award in 2019.
I understand that the child’s name and photograph will be displayed at the Children of Courage Award Presentation event.
Please Tick any of the following boxes that you are comfortable with.
(These are not a requirement of nomination, but will assist Lions Clubs in promoting
the awards. You will be contacted for verbal consent on each occasion the child’s
image is used and can withdraw your consent at any time.)
I give permission for the child’s photograph only (with no identification) to be used for promotional purposes for the Children of Courage Awards.
____________________________ __________________________ ___________
FIRST & SURNAME SIGNATURE DATE
Contact any of the Children of Courage Committee Members listed below for further information
Committee