WGGB Surprise Squad

Surprise Squad

The Gary Rome Auto Group and Western Mass News want to help honor your “Super Student!” Nominate your special student from 6th grade to 12th grade and they could win a visit from the Surprise Squad, including a $1,000 scholarship!
Nominator's Name*

First NameLast Name
Nominator's Address*

Street Address

CityState / Province

Postal / Zip Code
Nominator's E-Mail Address*
example@example.com
Nominator's Direct Phone Number*

Area CodePhone Number
Nominator's Relationship to Nominee*
Nominee's Name*

First NameLast Name
Nominee Age*
School Name*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nominee's Grade*
Grades 6-12 only
Reason for Nominating *
What would you like to surprise this person with?*
Any special interests?*
Will Western Mass News be able to film in their school?*

YesNo
Have children signed school release forms to be photographed?*

YesNo
Do you agree to have Western Mass News film at your school between 9:30AM and 11AM?*

YesNo
Note: If you are not a parent/guardian and you are a nominator from the school, you must receive consent from the parent/guardian to nominate the student and that no information provided violates FERPA.
You have read Gray Local Media, Inc.'s Standard Terms and Conditions at http://gray.tv/terms.pdf and agree to those terms in full.
I agree to the Rules, Terms and Conditions.*

Yes
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