Injury Submission Form

The mission statement of The Blake Dingman & Jake Dunham Holderwide Foundation is
“to provide non-discriminatory support to families and individuals impacted by
unforeseen injuries resulting from off-road accidents in Southern California.”

Thank you for assisting us as we seek to identify individuals from our desert community who have been injured in the Southern California area and have substantial financial need. As we formed our foundation to honor the boys, we knew choosing a recipient each year would be a difficult decision.
We would love nothing more than to be able to provide help to as many people as possible, however at this time we are only able to consider individuals who meet the criteria in our mission statement.

If you know an individual who meets the criteria in our mission statement,
please provide for us the following information for consideration.

* Indicates required field

Name *

First

Last

Date of Incident *

Short Description of how injury occurred and extent of injury: *

Injury occurred at what off-road location: *

Name of person submitting information: *

Relationship to Injured: *

Email address of person making submission *

Comment *

The Blake Dingman & Jake Dunham Holderwide Foundation Board prayerfully considers each circumstance.
The difficult decision of choosing our annual recipient is based on many factors including circumstances of the injury and need. Every individual is covered in extensive prayer.

-HolderWide Foundation

Submit