Santa’s Blazin’ Sleigh Bells – Child Nomination Form

Event Date: Saturday, December 13, 2025

Event Location:  Walmart of Show Low

Nominations must be submitted by November 30, 2025

TO SPONSOR A CHILD DONATE HERE

Nominator

Details of the person submiting the nomination.

Your Name *

First

Last

Organization or Agency (if applicable)

Phone

Email *

Child's Information

Details about the child being nominated.

Child's Name *

First

Last

School & Grade

GenderMaleFemale

Parent / Guardian's Information

Parent Guardian's Name *

First

Last

Relationship to child

Address

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone

Email *

Number of children in the home

Ages of children in the home

Have your child participated with Shop with a Firefighter before?YesNo

If YES - when

Why are you nominating this child? *

Email School home

Signature *

Clear Signature

I certify that the information provided is true and accurate to the best of my knowledge. I understand that submission of this form does not guarantee selection and that photos may be taken during the event for promotional use.

Submit

Join us in honoring Firefighters Brenna Kulikowski #1150 and Damon Thompson #1179.

 Friday, Sept. 26 | 5–9 PM
 The House, Show Low (1911 E Hall)

A portion of sales and all donations go directly to their families through the Arizona Firefighters Foundation.