Idaho Donor Quilt

This form has been designed to allow those touched by donation in Idaho to request a quilt square to be made in honor of their loved one. Volunteers have offered to design the squares and assemble the Yes Idaho Threads of Life Quilt.

Please fill out this form as completely as possible to help us create a square that best reflects your loved one's legacy.

Name of person submitting square *

First Name Last Name

E-mail *

Phone Number *

Area Code Phone Number

Name of person square honors *

First Name Last Name

Would you like their name on the quilt square? *

Yes No

Would you like the dates of their life on the quilt square? *

Yes No

If yes, what are the dates?

Your loved ones' favorite colors:

Your loved ones' favorite hobbies:

If you'd like to have a picture on their quilt square, please upload it here: (optional)

A scrapbook accompanies each quilt. In this portion, you may include any of the following that we will add to the scrapbook:

-a brief description of the square

-250-word or less personal history of the individual being honored or remembered

-photograph of honoree

-full name of person(s) the square honors/remembers

-date and type of donation/transplant, if applicable

Please include your text for the scrapbook submission below:

0/250

Additional photo or document for the scrapbook submission can be uploaded here:

Disclosure *

By checking this box I hereby consent to the use of my loved one’s name and likeness for the sole purpose of promoting organ and tissue donation. I understand that the use of his or her name and likeness may include, but not be limited to photographs, newspaper articles, brochures, displays, television, radio, or any other public community relations material. I hereby acknowledge that this authorization is volunteered without obligation of any kind on the part of Yes Idaho, or its designated agents.

If you have any question or you'd like to make your own quilt square and submit it via mail, please email Rebecca at simonr@ohsu.edu.

Thank you!

Example quilt squares:

Adopt a Square: Quilt Square Submission