4”x 8” Brick Information Form

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Name
Address
Is this gift in honor of someone?
Would you like us to notify someone of your gift?

Instructions

1. Please fill in the spaces with the letters/characters exactly as you would like to see them on your brick(s).
2. Leave spaces between names/words and before and after “&”. Please note: Spaces and punctuation marks count as characters.
3. Bricks will be randomly placed in the new ground level patio, in and around the outdoor dining area.
Please use the spaces below to write what you would like displayed on each brick. Each brick will have 6 lines with a limit of 15 characters per line. Characters include spaces and punctuation.
We respectfully ask for you to consider using “In Honor of [your loved one’s name]” language for your new brick inscription—rather than “In Memory of” content—out of respect for our current guest families who may have a child facing a life-threatening illness.

Brick Inscription

RMHC Philly reserves the right to approve the content of the message.