Blue KC Sporting Samaritans Nomination Form

Name (Nominator)

E-Mail Address *

Phone Number *

Nominee Information

Name *

E-Mail Address *

Phone Number *

Is your nominee a student, teacher, or teacher/coach? *

If they are a student, teacher, or teacher/coach, what is your school name and grade?

Explain in 250 words or less why your nominee should be selected as a "Blue KC Sporting Samaritan" *

To the best of your knowledge, is this person recognized as an outstanding student/educator and person of good character by other students/colleagues? *

The nominee is willing to be included in a press release if selected *

The nominee lives within 75 miles of Children’s Mercy Park *

I agree to the official rules ( *