Little Star Awards

Nominate a Little Star

Use this secure form to nominate a child for Little Star Awards 2008/09, or download a paper version of the form (PDF, 90kb). For more information please call 0113 263 6495 or email littlestar@cancer.org.uk.

Please email a picture of your Little Star to littlestar@cancer.org.uk to accompany your nomination.

Nominations are open until 28 February 2009.

We request that if you are not the parent or guardian of the Little Star you are nominating, you have informed their parent(s) of your intention and have their permission to proceed.

By sending in your nomination, you agree to the Terms and Conditions of the Little Star Awards.

Find out more about the Little Star Awards.

* You must complete the fields marked with an asterisk.

Person nominating a Little Star's details:

Your full name:

Daytime phone number:

Mobile number:

Email address:

Your relationship to the Little Star:

Little Star's personal details:

Little Star's full name:

Date of birth:

Age:

Sex:

Parent/Guardian full name:

Parent/Guardian daytime phone number:

Parent's email address:

Address line 2:

Address line 1:

Town / city:

Postcode:

Alternative daytime delivery address

Address line 1:

Addres line 2:

Town / city:

Postcode:

Additional information

		Little Star's hobbies / interests:

		Little Star's siblings (please include full names and d.o.b.) - this will be used for their certificates

		Please tell us in no more than 500 words why you have nominated your little star:

How did you hear about the Little Star Awards?

		Has anyone in your family previously supported Cancer Research UK? Please give details:

Little Star's medical history

Cancer type:

Date diagnosed

Age at diagnosis:

Date of last treatment

		Current health status:

		Any other non-cancer health issues:

		Please give details of any clinical trials they have taken part in:

Publicity

I am happy for my Little Star to help with publicity and I consent to details of our experience and names / pictures being used

I would prefer not to help with publicity