children with DIABETES - Quilt Submission Form



		Quilt Submission Form

Instructions:
Complete the following Quilt Information Form for each quilt square that you send. Each quilt square should be 3 feet by 3 feet (about 92 cm by 92 cm). Quilts with batting hold up and display better than single pieces of fabric.

Each quilt should be for one one person. Please do not send in one quilt for multiple people. Include the completed form with the quilt, and write your name on the back of the quilt and on any photos that you send.

Date:

Quilt Square Made For:
(For Example, Child's Name):

Birthdate:

Date Diagnosed:

Parent's Name if above person
is under 18 years old:

Address:

City, State, ZIP/Postal Code:

Country:

Phone:

E-Mail Address:

_______
Initial I understand that the quilt becomes the property of CWD and will be kept as part of the overall Quilt for Life. I also understand that the quilt squares may be photographed and used as part of other CWD projects to raise awareness of type 1 diabetes, including press releases, flyers, and other printed matter.

Signature

Mail completed form, along with quilt square, to:
Children with Diabetes
5689 Chancery Place
Hamilton, OH 45011
USA

Please wrap your quilt in plastic before placing it inside an envelope or box to ship. This will protect it from getting wet in transit.

Updated June 17, 2006

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Last Updated: Sat Jun 17 16:22:58 2006
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Date:
Quilt Square Made For: (For Example, Child's Name):
Birthdate:
Date Diagnosed:
Parent's Name if above person is under 18 years old:
Address:
Address:
City, State, ZIP/Postal Code:
Country:
Phone:
E-Mail Address:

_______ Initial	I understand that the quilt becomes the property of CWD and will be kept as part of the overall Quilt for Life. I also understand that the quilt squares may be photographed and used as part of other CWD projects to raise awareness of type 1 diabetes, including press releases, flyers, and other printed matter.

Signature