Until I can figure out the code where you can fill out the form online, You will need to answer the following info and email it to me at :
SurroundedByAngels@Juno.com

Please answer N/A if the question does not apply to the nominee :)
The form will be updated as I think of something new to add to it :)

Your name:

Your e-mail address:


Name:

Address:

City, State:

Zip Code:

Age:

*Optional*Email Address:

Birthday, if known:

Anniversary, if known:

In the military ?

Nominee's Religious or Spiritual Beliefs :

Hobbies:

Likes & Dislikes:

Favorite Scent:

Favorite Food:

Favorite Refreshment:

Favorite Snack:

***Important!***
Allergic to anything ?

Any disabilities ?

If the nominee is under 18,
Do they have siblings in the household?
If so,Please list their names,ages,likes,and
dislikes.





Brief statement about why you feel this person needs an angel and a little of their situation:




Anything else you would like to add about this person ?