Full name of person you wish to encourage: *
City and state of recipient's residence:
Age of person you wish to encourage:
Is the recipient related to you and how?
Recipient's nicknames for you:
Your nicknames for the recipient:
Names, ages and sexes of recipient's children:
Why does the recipient need encouragement? *
List any other thoughts, facts, stories or memories you might wish to include in your gift of poetry for the recipient:
Stories or memories that would be important to this encouragement:
Is there some humor you shared that could bring light and laughter to a difficult time?
Activities you enjoy doing with the recipient:
Recipient's interests, hobbies and talents:
Anecdotal or humorous stories about the recipient:
Would you like this poetry to have a religious or spiritual theme? *
Where does the recipient generally turn for encouragement (friends, religion, spirituality)?
How do you want to let the recipient know that you and others will be there for him or her?
Names, ages, and sexes of your fiancee's children, if applicable:
What does recipient do for a living?
Additional comments, notes or instructions that you would like our writers to consider in creating your gift of poetry: *
How has the recipient ever encouraged you?
Describe your relationship with the recipient:
Special moments shared between you and the recipient:
Does the recipient have any children or step-children?
Your relationship to
poetry recipient: *
Daytime phone number and best time to call: *
Evening phone number and best time to call: *
Special instructions or comments and date poem is needed: *
* Denotes required field.
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.
Is the recipient married?
Recipient's physical traits (e.g., height, hair color, eye color, strong, handsome, pretty,
intelligent, witty, talented, etc.):
Recipient's character traits (e.g., supportive, loving, kind, thoughtful, caring, dedicated,
hard worker, nurturing, unselfish, etc.): *
"special words for special people"