Good Neighbour Nomination Form

Click the button below to complete the Good Neighbour Nomination Form.

All personal information supplied as part of the Good Neighbour Recognition Program will be used by the Municipality of Chatham-Kent pursuant to the requirements under Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) in order to acknowledge and recognize good neighbours across the municipality. Their personal information will be shared with Partnership Development staff as part of the Good Neighbour nomination process.

Your name.

* required

Maximum 255 characters

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Your email address

* required

Maximum 255 characters

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Your phone number.

* required

Maximum 255 characters

0/255

Your mailing address, including postal code (i.e. 123 King Street West, Merlin, ON N0P 1W0)

* required

Maximum 255 characters

0/255

Submitting the nomination on behalf of? (click all that apply)

* required

Neighbour's Name

* required

Maximum 255 characters

0/255

Provide the neighbour's mailing address, including postal code (i.e. 123 King Street West, Merlin, ON N0P 1W0)

Maximum 255 characters

0/255

Do you know the person who you wish to nominates contact information?

* required

Yes

Reason(s) for nominating the neighbour.

* required

10.

We would love to share some of these stories to help inspire others to help their neighbours. Do we have your permission to share this story on social media or on our website? Only the first name of the nominator and nominee, if provided, will be used and no other identifying information will be shared.

* required

Yes