Camp Ta-Kum-Ta
Nomination Form

Camp Ta-Kum-Ta and Sail Beyond Cancer VT are partnering to offer private sailing excursions for campers and their families so that the entire family may experience the healing powers of wind, water and sail - to cast off

and leave the effects of cancer behind for the day.

TA-KUM-TA

SAIL NOMINATION

Nominator First Name

Nominator Email

Nominator Last Name

Nominator Phone

Nominator Street Address

Nominator Street Address Line 2

Nominator City

Nominator Region/State/Province

Nominator Postal / Zip code

I am nominating my son/daughter

Yes

Nominee (Camper) First Name

Nominee (Camper) Last Name

Nominee (Camper) Age

Nominee Family Name

Nominee Parent Contact Email

Nominee Parent Contact Phone

Nominee Parent Street Address

Nominee Parent Street Address 2

Nominee Parent City

Nominee Parent Region/State/Province

Nominee Parent Postal / Zip code

Type of Cancer

In remission or in treatment?

In treatment

In remission

A summary of why you are nominating this person:

I am nominating anonymously

I agree to verify my email

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Thanks for nominating!

Camp Ta-Kum-Ta Nomination Form

TA-KUM-TA

SAIL NOMINATION

Camp Ta-Kum-Ta
Nomination Form