Receive a Quilt

To receive a quilt please fill out the following information and email it to christine@mitoquiltsofhope.org

Name of Recipient:

Age of Recipient:

Full Address (including street, city, postal/zip code & country):

Are you willing to have your name and address released to the quilter for shipping purposes? Yes or No?

Phone:

Your Email:

Requested Quilt Size:

Are you a member of the following organizations?:

  • MitoCanada: Yes or No
  • MitoAction: Yes or No

May we release your information to the following organizations?:

  • MitoCanada: Yes or No
  • MitoAction: Yes or No

A description of the recipient’s medical situation, diagnosis, and need for a quilt:

We would love to have a picture of you with your quilt. Please submit a picture to christine@mitoquiltsofhope.org

We anticipate a high demand for quilts and cannot promise when you will receive it so please be patient. The quilts will be distributed on a first come first served basis, although we do reserve the right to distribute a quilt on a high priority basis based on need.