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Christmas Wishing Tree Nomination
You can complete this form on behalf of your own household or to nominate a household who have been affected by the 2022 floods.
While we cannot guarantee that we can assist everyone who is nominated we will try our best to complete all requests.
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* Indicates required question
Person completing this form (name and phone)
*
Your answer
Are you completing this form for your own household or nominating a household
*
Nominating own household
Nominating a different household
How many people reside in the household
*
1
2
3
4
5
Other:
Contact name for household
*
Your answer
Contact number for household
*
Your answer
Ages and genders of people in household
*
Your answer
If known interests of those in household
Your answer
Does the household need a Christmas tree?
Yes
No
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