Nominate a Qualifying Patient and/or their family

for an Experience and/or Expedition:

Nomination Guidelines:

Please note the following disclosures and nomination guidelines before nominating anyone:

1) Nominations are open to current patients 18 and under of approved medical service providers including IU Health, Riley Hospital for Children, St. Vincent/Ascension, Peyton Manning Children’s Hospital at St Vincent and Community Health Network.  Others may be considered on a case by case basis. Patients must be currently receiving treatment for major chronic or critical illness and/or injury.

2) Once nominated, a patient who remains under consideration for inclusion in a program or “experience” will be required to provide their physician with a medical release form and a nomination/referral to continue through the evaluation process.   Those who do not return the forms with 7 days of notification of consideration, will no longer be under consideration for the next experience. However, they may submit it for consideration of a future experience. 

3) There are limited spaces at limited events and spaces at each event. Therefore, not all are nominated are guaranteed to be selected to participate.

4) If you are not the parent or guardian of a child being nominated, YOU MUST have the consent of the parent/guardian of the patient of family you are nominating.

5) Colby & Cate’s Charities Inc. IS UNABLE TO PROVIDE ANY MEDICAL SERVICES at any of our events and/or experiences.  

6) Nominations submitted for those who have participated in a past event, Experience or Expedition are eligible, but, please understand we will attempt to fill all spots with patients and/or families who have not participated in an event, Experience or Expedition hosted in whole or in part by Colby & Cate’s Charities in the past.   Thank you for understanding.

7) All those selected will be required to sign our standard liability release prior to participating an any event, Experience or Expedition.

8) Those selected will also be required to sign a release allowing Colby & Cate’s Charities to use photos, video and other recordings on our web site and in other marketing materials. 

By entering your name in the box below, you confirm you have read and understand the nomination guidelines above. (required)

Your Email (required)

Your Relationship to Patient (required)

Parent / Legal Guardian Name (required)

Parent / Legal Guardian Phone Number (required)

Parent / Legal Guardian Email (required)

Patient Name (required)

Patient City (required)

Patient State (required)

Patient Age (required)

Patient Grade (required)

Hospital Serving Patient (required)

Health Condition (required)

Number in Family (Same Household) (required)

Why Have you Nominated This Child?

Spam Prevention: (required)

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