Request A Song – Songs of Love

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Email info@songsoflove.org • Phone 1-800-960-SONG (7664) • DONATE NOW

About Us
Request A Free Song
Listen To Music
Songwriters
Ways To Help
Bitcoin Donations
Contact

CLICK HERE FOR HELP FILLING OUT FORM

“Song of Love” Request Form

Once you fill out our song request form for a FREE “song of love”, you will be able to also receive a FREE cake from our friends at Icing Smiles! Now you can add a little sweetness to your “Song of Love”!

- Step 1 of 4

Child Info

(All fields with an * are required and must be filled in. Please make sure form is completely filled out before submitting it.)

Haga clic aquí para el perfil en Español.

(Click above for our Spanish request form)

Child's First Name *

Child's Last Name *

Age *

Gender *

If child identifies differently, please specify below

Child's Diagnosis (To Determine Eligibility Only) *

Please include name of Affiliated Hospital / Health Facility / Hospice / Clinic or any other facility *

Check box if you'd like to provide additional medical facility information

Medical Info

Medical Facility

City

State

Phone

If other/international country, please add complete address below:

Names to be included in the song :

Family Members, Friends, Pets, etc. *

Please Use This Space To Spell Names Phonetically For Proper Pronunciation

What makes your child happiest?

Favorite things, hobbies, foods, movies, heroes, etc. *

Style of Music (Please check at least 3 of your child's favorite kinds of music) *

Uplifting Children's music
Pop
Dance
Rap/Hip-Hop
R&B
Rock
Country
Soft & Soothing
Any style

Parent or Guardian Info

Name *

Address *

City *

State *

Zip *

Phone *

Email *

Check box if song should be sent to an address different than the one above

Where Should Song Be Sent

Name

Address

City

State

Zip

How Did You Hear Of Songs of Love?

Please choose one: *

If other please specify

Publicity Release

I, the undersigned, hereby grant to Songs of Love Foundaton (Songs of Love) the right, license, and privilege to use my name, likeness, photograph, voice, and biography, as well as the "Song of Love" written for the above-named child in such a manner as Songs of Love shall deem appropriate, (including but not limited to fundraising, etc) in order to promote, advertise, and publicize Songs of Love and its charitable activities.

Digital Signature *

Date *

Allow for publicity *

Upload Photo

Click or drag a file to this area to upload.

If possible, PLEASE upload a photo of child. (max file size:10mb)

Name

Also, you can download this form for email, fax, or mail by clicking here.(Not all Firefox browsers support fillable PDF files. If this is the case download the form, fill it out and email it to: songwriter@songsoflove.org.)

Special Thanks to American Legion Child Welfare Foundation

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Song Request Page Help

Fill out the following and one our song request specialists will contact you.

Name *

E-mail *

Phone *

Comment

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