Songs of Love Foundation | Request A Song of Love - Songs of Love Foundation
Listen to Songs of Love on Spotify! We provide personalized songs, free of charge, for children battling serious illness and lifetime disabilities.
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Request A Song of Love

If your child is 21 or younger and is battling a serious physical or emotional medical challenge,
you can request a free “song of love” by filling out the form below.

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 just download the form, fill it out and email it to:

(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.


Child's Name*    Age*   Gender* MaleFemale

Special Interests, Hobbies, Favorite Things*

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

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

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.

Medical Facility*

City*    State*    Phone* (Include Area Code) --

If different country, please add complete address below:

Contact Name*

Contact Title*

Contact Email (optional)

Child's Diagnosis* (To Determine Eligibility Only)    Check box if child IS in the hospital.

Info About Parent Or Legal Guardian

Name*   Address*    City*   State*   Zip*

Phone* (Include Area Code) --    Email*

If different country, please add complete address below:

Where Should Song Be Sent   Check if address is the same as Parent/Legal Guardian
Name   Address    City   State   Zip

If different country, please add complete address below:

How Did You Hear Of Songs Of Love?* (Please Choose One)Music MessengerHospitalFriend/RelativeTV/RadioWebsiteMag./Newsp. AdsOther
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.

Name of Parent or Guardian*   Name of Minor*   Allow for publicity.*YesNo

Digital Signature*   Date* (Month/Day/Year ex. 11/10/2008)

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

Enter the code above here :