Print this form or copy it onto a word document and send it in.  Phone requests are also taken.

Tioga County Chapter

Stella Boyer – Chapter Coordinator

96 Targosh Road

Candor, NY 13743

(607) 659-3556

stellaboyer@hotmail.com

BLANKET REQUEST FORM

Name of Institution: _____________________________________________________

Address: ______________________________________________________________

               ______________________________________________________________

Name of contact person: __________________________________________________

Phone number and e-mail: ________________________________________________

Best time and day to drop off blankets: ______________________________________

Please check one:

___ Yes!  We would like ___ (fill in desired number) Project Linus blankets.

___ No, we do not need any blankets at the moment, but please contact us again in ___ months.

___ No, thank you.  We are unable to make use of any Project Linus blankets.

            Please Explain ___________________________________________________

Number of blankets needed:

___ baby blanket (approximately 30 inches square)

___ children’s blanket (approximately 40 inches by 60 inches)

___ other size needed, please call for more information

Type of blanket preferred (depends on availability):

___ any type will do

___ knitted/crocheted blankets preferred

___ quilted blankets preferred

___ fleece blankets preferred

___ we can only use ___________________ blankets (please specify type)

Please check one:

___ Please contact us in ___ months to see if we need more blankets.

___ We will contact the Tioga County Chapter of Project Linus when we need more blankets.

Thank you!!