Request A Free Song

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. *

We will do our best to include all the names given but please limit the amount of the names. If too many are submitted we might not be able to get them all in. There is a 150 character limit

Please Use This Space To Spell Names Phonetically For Proper Pronunciation

If a unique name pronunciation is not mentioned we cannot add them into the song. If the main child name is unique and pronunciation is not mentioned we cannot create the song. If you like you can send us a voice message with the pronunciation to songwriter@songsoflove.org.

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

Wish Granter

This only pertains to Make-A-Wish profiles. If other, skip to next section.

Wish Granter Name

Wish Granter Email

How Did You Hear Of Songs of Love?

Please choose one: *

If other please specify

Publicity Release

I, 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.

Allow for publicity *

ALL children will receive a 'song of love' regardless of the publicity choice

Digital Signature

Date *

Upload Photo

Drag & Drop Files, Choose Files to Upload

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

Free “Song of Love” Request Form