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Your full name: *
Your relationship to
poetry recipient: *
Your mailing address: *
Daytime phone number and best time to call: *:
Evening phone number and best time to call: *
Your email address: *
Special instructions or comments and date poem is needed: *
Provide us with the requested information about yourself.
Then complete the poetry information request form below as you are able. Remember, the more detailed the information you provide, the more personal and unique the gift.
If recipient is not a family member, describe the details of your first meeting:
If recipient is a family member, what are your memories of him or her as a child or young adult?
List any other thoughts, facts, stories or memories you might wish to include in your gift of poetry for the recipient:
Memories of your times together (childhood events, dates, vacations, outdoor activities, friends, family getogethers, romantic moments):
Activities you enjoy doing with the recipient:
Recipient's interests, hobbies and talents:
Anecdotal or humorous stories about the recipient:
What special words would you like to say to the recipient? *
How do you feel about the recipient and why are you thankful for him or her? *
If recipient is not a family member, what were your first impressions of him or her?
By spiritual emphasis, do we refer to God or Jesus specifically? *
Full name of the recipient of this poetry gift: *
Your nicknames or pet
names for the recipient:
Occasion for poetry (e.g., for Easter or for Spring): *
Recipient's nicknames
or pet names for you:
What are your plans for the future with the recipient, if applicable (long friendship, marriage, etc.):
Additional comments, notes or instructions that you would like our writers to consider in creating your gift of poetry: *
* Denotes required field.
Physical traits of recipient (e.g., height,
hair color, eye color, petite, beautiful, cute, strong, handsome, intelligent, witty, etc.): *
Character traits of recipient (e.g., supportive, loving, kind, thoughtful, caring,
hard worker, nurturing, unselfish, etc.): *
Age or date of birth of the recipient? *
Recipient's relationship to you (friend, family, romantic): *
If for Easter, do we include a spiritual emphasis? *
If for Easter, do we refer to the Easter bunny, eggs or candy? *
If for Easter, do we refer to new clothes, church attendance, etc.? *
If for Spring, do we acknowledge nature (flowers, rain, etc.)?: *
If for Spring, do we acknowledge God's recreative power? *
If for Easter, do you have plans with the recipient? *
If yes, what are your Easter plans (church, egg hunt, easter basket)? *
Why is the recipient special to you?
How long have you known the recipient?
"special words for special people"
