Child Nomination

Just like any child - Jewel was smart, fun and FULL of energy... she was always ready for an adventure! The Jewel Emma Foundation was born to allow other children to have their own adventures. If you are wanting to nominate a family with several children - please list all their names and ages in the appropriate fields. If you are wanting to nominate more than one child from different families, please fill out a separate form for each child.

Your Name: *

First

Last

Email: *

Phone number:

Name & age of child: *

Reason for nomination: *

Parents name & contact info: *

What would this child benefit from? (can choose more than one - but most likely will only be gifted one) *

Other idea:

Comments, questions and/or concerns: