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Add a Tribute to the Wall of Fame

Thank you for adding your "little hero" to our Wall of Fame! Please fill out the form for your child below. You can also send us your Wall of Fame submission and photo via mail at: P.O. Box 357672, Hoffman Estates, IL 60195. We will be sure to return your pictures to you!

If your child is already on our Wall of Fame and you would like to change his/her entry, please email us and let us know what you would like to change.

Fields marked with an * are required.

About your child

Type of Tribute

In Memory In Honor

First name *

Middle Name

Last name

State

Born

Diagnosed

When your child grows up, s/he wants to be...

Child's family

Child's pets

Child's favorite place

Child's favorite thing

Child's favorite movie

Child's favorite song

Tell us something special about your child:

Child's photo (JPEG image should be about 200x300 and less than 100k)

Child's video (enter embed code provided from YouTube, Vimeo, etc.)

Can NCCS use information about your child in its newsletter and other publications?

Yes No

About you

Please provide your personal information in the fields below. This information is for security and contact purposes only, and will not be displayed on your child's Wall of Fame page.

First name *

Last name *

Address

City

State

Zip

Email *

Phone

Relationship to child *