Nominate a special needs Child for this innovative program

Nominate a Child - Nomination Form

Please complete all fields for nomination to be considered

All nominees must be under the age of 18. They must have a special need. Guardian must own their own home or have written permission to paint on the walls if renting. All nominees must live in Palm Beach Florida county.

Full Name of Nominee*

First Last

Home Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Special Need*

Are you the:*

Parent
Guardian

Your Full Name*

First Last

Home Phone*

Cell Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Your Email Address*

Enter Email Confirm Email

I certify child is under 18 years of age*

How did you hear about “Paint For Children”*

Please provide a brief description of the person you are nominating. Why are you nominating this person? What makes them special? In your eyes*

Upload Childs Image

Accepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.

A picture, not publicly displayed for Board of Directors file.
jpg, png, pdf files only. Thanks!

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Nominate a Child - Nomination Form

Please complete all fields for nomination to be considered

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