Love Quilts Form

All information is required unless it does not apply to your family.  Please put N/A in the boxes that do not apply. This form must be complete to be considered for a quilt.  Any questions can be emailed to me at LoveQuilts1999@aol.com.

No information will be posted on the Love Quilts website with the exception of the first name and last initial of the child, the birthdate of the child, the main diagnosis of the illness and the biography. All other info will be kept private and only given to those that will be finishing and mailing the quilt to your child.  If the parent wishes the child's website to be listing on their Love Quilts page permission must be emailed to me.  If no permission is given the website will not be listed.

Child's Information

Full name of child (First, Middle and Last):

Birthdate of Child (Month, Day, Year):

Main Diagnosis (please use medical names,

DO NOT list a webpage address here):

Date of Diagnosis:

Other Diagnosis:

*REQUIRED FOR QUILT! No exceptions*

Webpage for child giving updates on child: (such as caringbridge etc. or any site that features your child with a bio such as Make A Child Smile, Hugs and Hope, etc. If using a site such as MACS, H&H etc. please direct me to the exact page where your child is featured):

Family's Information

* All information below will be kept private! *

Full Name of Father (First and Last):

Full Name of Mother (First and Last):

Last name of the family (if different from the child's):

Siblings and Birthdates (Example:

Bob, 1/1/90, Sue, 2/2/92 etc.):

Home Address:

City, State and Zipcode:

Snail mail address where quilt should be mailed (if different then above):

Phone Number (only used if we are unable to get a hold of you via email and will be kept private):

Correct Email address for us to use (Kept Private):

Alternate Email address for us to use if

main address doesn't work for some reason:

Form submitted by: (If submitted by anyone other then the parent permission must be received from the parent before child is featured.  Please DO NOT put N/A here, for legal reasons this must include the parents name who submitted the form.)

Quilt Information

Child's Interests and favorite color (Please make this listing as detailed as you can):

Theme of Quilt

Below is a listing of theme choices that we feel will have enough pattern choices for the stitchers.  We do try and fill special requests when we can, but those requests must be approved in advance.  Please pick 3 possible themes you would like and put them in your preferred order.  We will only use ONE of the requested themes for your child's quilt!  We will try and fulfil your first request if possible, but please know that we may approve one of the others.  This might occur if there is over use of the theme for that year (makes it hard to get stitchers to sign up).  Please fill in all 3 spaces from the theme listing below:

Themes 

Please look over this listing carefully before making your choices.

If possible, please pick only one... unless you are combining two like

themes... example would be Heroes and Patriotic together.

Please remember to enter your theme choices in spaces provided above.

These themes are catagorized under Generic themes, Boy Themes and Girl themes.  You know your child best.  If I list a theme under boy but it is something your daughter might like please feel free to use it or the other way around as well.

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Generic Themes: Will work for a boy or a girl

Toys: Any toys will work *NEW THEME CHOICE!

Farms: not just farm animals but anything farm related *NEW THEME CHOICE!

Foods "fun foods" *NEW THEME CHOICE!

Music *NEW THEME CHOICE!

EMS Animal Babies (please follow this link to view a sampling of these patterns) *NEW THEME CHOICE!

Circus *NEW THEME CHOICE!

Space - planets, astronauts, aliens, spaceships *NEW THEME CHOICE!

Kids being Kids: would have a child doing something in each square.  Can be for boy or girl depending on the child *NEW THEME CHOICE!

School *NEW THEME CHOICE!

Winter Sports: Only generalized sports that are traditionally done in winter *NEW THEME CHOICE!

              

Summer Sports: Only generalized sports that are traditionally done in winter *NEW THEME CHOICE!

Family Pets *NEW THEME CHOICE!

Under the Sea: Sea Life found under the water

Down by the Sea: things above the water.... sandcastles, beach umbrellas, flip flops, shells *NEW THEME CHOICE!

Basic Sports

Soft Animals: animals you would want to snuggle

Birds: can be soft birds for girls or masculine birds, such as Eagles or Hawks, for boys, please specify

Heroes: such as firemen, policemen, paramedics... etc.  NO SUPERHEROES PLEASE, due to lack of patterns for that theme.

Patriotic Theme: any pattern that celebrates us as Americans

Wild West: would include all of the following and more... Horses, Hunting Dogs, Oregon Trail, Indians, Cowboys, Cowgirls... anything that would look like the old west. Theme would not include any cowboys with guns shooting or indians with arrows shooting, but might include indians holding a bow. Guns are to be left out of this theme by the stitcher. 

Australia

A specific Animal: pick a common animals such as Cats/Kittens, Dog/Puppies, Horses, Pigs ect.

Angels: can be angels for boys or angels for girls, specify

Religious Theme: in order to have enough patterns it must be Christian

Lighthouses 

Noah's Ark

A Color Theme: This theme is where the pattern has to have the color in it somewhere but can be any pattern. They turn out really cute.  Please pick a main color such as pink or blue etc.

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Girl Themes:

Hearts: will have hearts in it somewhere, will include other girly things *NEW THEME CHOICE!

Princesses *NEW THEME CHOICE!

Toys for girls: specific to toys only related to girls such as dolls etc.

Flowers

Flowers with bugs such as butterflies and dragonflies

Teddy Bears

Precious Moments

Dance: like ballet, tap cheerleading... anything related to dance

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Boy Themes:

Toys for boys: boy toys, can even include older things boys still consider toys

Heavy Equipment Machinery  *NEW THEME CHOICE!

                    

Race Cars (would be very colorful)  *NEW THEME CHOICE!

In the Air: balloons, blimps, planes and rockets  *NEW THEME CHOICE!

                     

On the Water: all boats, jet skis and rafts etc.  *NEW THEME CHOICE!

Great Outdoors: this would be camping and fishing and hunting (no cartoons) *NEW THEME CHOICE!

Generic Engine: anything with an engine

Wild Animals: please list a few of the child's favorite animals

Generalized Engine Theme: anything with an engine... cars, trucks, planes, boats... etc. 

Only Trains 

Please submit a photo of your child to LoveQuilts1999@aol.com OR you may snail mail it to:

Cathy Strzyinski, Love Quilts, 185 Richland N., Hemlock, Mi. 48626

If mailed via snail mail you must have a self addressed stamped envelope if you wish to have your picture returned to you. Photo must be submitted before child is featured for a quilt. You may direct me to MACS, H&H or any site that has featured your child with a picture if you are able.  If you wish for me to take a photo from their webpage please let me know which one if there is a preference.

Biography on Child

Begin story from birth, then signs of illness, diagnosis and what he/she has been through until today. Please write at least 3 paragraphs. This information will be posted on the Love Quilts webpage created for your child. If you have another site where your child is already featured such as Make A Child Smile or Hugs and Hope etc. and there is a full bio listed you can just direct me to the page your child is on. Please make sure you direct me to the exact page and not just the homepage of the site.

Please read this entire page in full before submitting your child to receive a quilt from Love Quilt!

Thank you for your interest in submitting your child to receive a quilt from Love Quilts.  By submitting this form you are agreeing to allow Love Quilts to feature your child's picture and basic information on our site (personal information such as your last name, location, email address etc. will never be posted by Love Quilts).  Please note, form must be filled out by a parent or guardian! 

Once the form is received it will be reviewed and we will then decide if the child fits all the requirements to receive a quilt from Love Quilts.  You will be notified by the email address you provide to us if your child is approved and you will be given an approximate time frame for the quilt to arrive.  Please note it can take 1-12 months to get a quilt depending on the child's illness and theme choice. 

Although we will try our best to make a quilt for your child, not all children will be accepted.  If you wish to be given a reason your child was not accepted for a Love Quilt please send an email to LoveQuilts1999@aol.com and I will do my best to explain. 

Below is the form you will need to fill out to be considered for a quilt.  Here are some of the basic rules for a child to receive a quilt from Love Quilts.

 

1. Child must be between the age of 6 months and 18 years old when the quilt is finished.

2. Child must live in the U.S.

3. Child must be currently seeking treatment for a life long or a life threatening illness.

4. Child must have an online active webpage (such as caringbridge.com) that updates on the child's condition often.

If you feel your child meets these guidelines please feel free to fill out the form.  You will receive an email to notify you if your form was accepted.  Thanks!

Theme Choice #1:

Theme Choice #2:

Theme Choice #3:

Has your child received a quilt in the past from another group online or locally? (this does not include virtual "quilts" posted only online)

Religion (optional):

If you have answered Yes to the question above, please explain what kind of a quilt it was and when it was received.  If you could include a picture of it that would help as well.

Please note!  By hitting the submit button you are giving your electronic signature agreeing to have your child featured to receive a quilt from Love Quilts.  If you have any questions please feel free to email me at LoveQuilts1999@aol.com.  Thank you!

YesNo