THE "BREATH OF LIFE" QUILT PROJECT

I, _______________________________________ (printed name), hereby donate this quilt block to the "Breath of Life" Quilt Project on this day, _____________________________. (day/month/year). 

I acknowledge that the Breath of Life Quilt Project is the owner of this block and documentation.  I understand that items submitted to the Breath of Life Quilt Project may be viewed by the public.  I assign to the Breath of Life Quilt Project all rights, title, and interest to all items I have submitted.  (Please be advised that your personal information such as address, email address, and phone number will be kept confidential.)

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Signature of donor
 

Email Address:______________________________________
Phone Number:______________________________________
Address:_____________________________________________________________________
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