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 us at Vicki4LoveQuilts@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.

Pick three different themes.  You may combine 2 themes if you wish - such as asking for heroes (military) and patriotic themes combined as one choice.

Love Quilts will make every effort to give you choice #1, but if a theme has been used several times recently we may ask to use your second or third choice.

You may suggest themes not seen on this list and we will honor those requests ONLY IF there are enough patterns available to make stitching the quilt possible.

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

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Generic Themes: Will work for a boy or a girl

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.  Give a list of the child’s favorite things or activities.

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

Animals:

   Soft animals (real or stuffed-animals you want to snuggle).

   Family pets

   Wild animals

   North American animals

   Jungle animals

   Farm animals

   Any specific animal (dogs, cats, pigs, cows, frogs, horses)

   Birds (songbirds and colorful birds for girls) (masculine birds such as raptors or game birds for boys)

Toys: Any toys will work

   Dolls

   Boy toys

   Girl toys

Foods "fun foods"

   Sweets

   Fast foods

Music All music, Dance

EMS Animal Babies (please follow this link to view a sampling of these patterns)

Farms: not just farm animals but anything farm related

Circus

School

Sports

   Basics sports (any)

   Winter Sports:

   Summer Sports:

   A specific sport

The Sea

  Marine animals (fish and mammals)

Down by the Sea: things above the water.... sandcastles, beach umbrellas, flip flops, shells, lighthouses

Special places - things you would see in a particular part of the world

   Africa

   Australia  

   Hawaii

   Alaska

   Any location with distinct things which characterize it.... buildings,     landscapes, animals, way of dress

Under the sea: fish, plants, divers, shipwrecks

Patriotic Theme: any pattern that celebrates us as Americans

Religious Themes: Angels (boy or girl)

   Noah (ark, animals, people)

   Christian (crosses, Bible verses, hymns)

Boy themes

Heroes:

  First responder (Police, fire, EMT)

   Military

Cartoon superheroes (due to limited patterns and extreme popularity may not be able to honor this request so be sure to pick a second and third choice which is different)

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. Specify if you do NOT want weapons in the pictures as many WW patterns include a person holding a rifle or a bow and arrow.

Space - planets, astronauts, aliens, spaceships

Vehicles and Machinery:

   Generic Engine (anything with an engine)

   Heavy Machinery (steam rollers, road building machinery)

   General engines theme (cars, trucks, planes, boats)

   Cars

   Race cars(very colorful)

   Trains

   Planes

   Anything in the Air (balloons, blimps, planes and rockets)

   On the Water: all boats, jets skis, rafts, etc.

Great Outdoors: this would be camping and fishing and hunting (no cartoons)  Can specify for a particular state or area of the country

Girl Themes

Words and phrases

  Inspirational

Pick a particular word ie HOPE, FRIENDSHIP, FAMILY, FAITH, LOVE

Word  themes will include squares with phrases or pictures which depict                      the word -- as friends might show 2 girls hugging or a saying about friendship

Hearts: will have hearts in it somewhere, will include other girly things

Precious Moments

  Any Precious Moments picture

   PM children

   PM animals

   PM angels

Flowers or Flowers with bugs such as butterflies and dragonflies

Teddy Bears or stuffed animals

Dance

  Ballet  

   Any type of dance  and cheerleading

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 Vicki4LoveQuilts@aol.com and we will do our 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 2 years and 18 years old (while still in high school) 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 physical 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 us at Vicki4LoveQuilts@aol.com.  Thank you!

How did you find out about Love Quilts?

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