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1-800-960-SONG (7664) 24,900 children have received
a Song of Love as of 01/30/15

You can download this form for email, fax, or mail by clicking here
Clique aquí para el perfil en Español Aqui

(Family Members, Friends, Pets, Type of Music, Etc.)

Please Use This Space To Spell Names Phonetically For Proper Pronounciation:

Songs are delivered on CD approximately 4-8 weeks after request is received and can be performed in any language.
In case of special circumstances, please call us at 1-800-960-SONG and we can have your song ready as quickly as possible.

(Include Area Code)

Check box if child IS in the hospital.

Check if address is the same as Parent/Legal Guardian

(Please Choose One)
Music MessengerName Hospital Friend/Relative
TV/RadioSpecify Website Mag./Newsp. AdsSpecify

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.

(Month/Day/Year ex. 11/10/2008)
Check this box if you DO NOT want publicity.

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If possible, PLEASE email a photo of child to Sara@songsoflove.org.