Section 1: Nominator Information

 I am nominating myself. I am nominating a family.

Relationship to Nominee

Your First Name

Your Last Name

Your Email

Your Phone

How did you hear about the Re-Wild program?

Section 2: Family Information (must have an address within Elgin County)

First Name (Parent/Guardian)

Last Name (Parent/Guardian)

Address

City

Postal Code

Email

Phone

Number of family members

Age of child 1 (must be less than 18 years old)

Age of child 2 (must be less than 18 years old)

Age of child 3 (must be less than 18 years old)

Age of child 4 (must be less than 18 years old)

Age of child 5 (must be less than 18 years old)

Does the family have access to a vehicle?

Is the family new to camping?

Section 3: Additional Information

Why does this family need to be re-wild?

Why does this family need to be re-wild? Describe why you feel this family needs to experience the joy of camping. Please describe their nature deficit (i.e. financial hardship, social hardship or other unique circumstance) (250 words or less)

If you wish, please share any additional information that will help us assess your nomination for Re-Wild the Family (250 words or less)

Section 4: References

If you are nominating yourself for the Re-Wild program, please provide us with one (1) reference. References are non-family members who know you and your family and why you would benefit from the Re-Wild program. Examples of good references are teachers, social workers, coaches, tutors, religious leaders, doctors and day care workers.

Name of Reference

Relationship to Family

Reference Email

Reference Phone

Contest Rules

How to Enter/Eligibility: There is no purchase necessary to enter this contest. All families nominated must live within Elgin County to be eligible for this competition and subsequent prizes. Nomination forms can be dropped off or emailed to the specified address prior to the contest closure.

Contest Deadline: Nominations will be accepted and evaluated until all available spots are awarded in a given year.

Winner Selection/Notification/Disqualification: Contest winners will be selected by the Kettle Creek Environmental Trust. Prize winner will be notified via email or phone. If no response is received within 7 days of notification, contest winners will forfeit their prize and the prize will be re-allocated to the next most qualified nominee. The decisions of the Kettle Creek Environmental Trust are final. The Kettle Creek Environmental Trust reserves the right to accept and/or reject any and all nominations, including a decision not to name a prize winner. The prize is not transferable to another family. All families selected will be required to sign a waiver.

Privacy: Kettle Creek Environmental Trust will not sell or share your personal address and information. Contact information is required and collected only for the purposes of communicating with nominators, nominees and prize winners.

 I have read and understand the above rules and contest criteria.

 I have read and understand the accompanying “Rules & Instructions” page.

Rules & Instructions