Nominate A Child Do you know a child who deserves to go to Disney Land? Please review our Child Criteria and then enter the information below. Please note that submissions will only be accepted until MARCH 20, 2020. Tell Us About YouYour Name* First Last Your Email Address*Just in case we need to get a hold of you. Your Number*Tell Us About The ChildPlease fill in the fields as best you can.Child's Name* First Last Main Parent or Legal Guardian Name*Phone*Primary contact number for Main Parent or Legal GuardianEmailIf available email address for Main Parent or Legal Guardian Enter Email Confirm Email Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Child's Birth Date* Date Format: MM slash DD slash YYYY Why do you want to nominate this child?*Does this child have any special needs?*NoYesIf "Yes" please describe belowIf the answer above is "Yes", please use this space to provide more information.Is the main Guardian of this child aware of this nomination?*NoYesConsent* I have read and understand the Child Criteria.*I have verified that the child being nominated has not been to a commercial theme park as of the date of this nomination:*NoYesCustody Status*Please describe the Custody Status of this child.Lives with both parentsLives with one parentI am the parentLives with foster parentLives with other family memberParent with sole custodyOtherI am not sureIf you have a letter in support of this child's nomination, please feel free to upload it here.Letter can be from yourself or another member of the community that knows this child. It is helpful for the child selection process if the letter provides as much information as possible to support this child's nominationAccepted file types: jpg, gif, png, pdf, doc, docx.CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.