Blythewood Historical Society and Museum
Quilt #:
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Consent Form
Ownership of this quilt is: ○ Private
○ Public
○ Public Museum, Library or Institution
Name of quilt owner:
Quilt owner street address:
Quilt owner city:
Quilt owner county:
Quilt owner state:
Quilt owner reservation:
Quilt owner province:
Quilt owner zip/postal code:
Access and copyright information for image:
Quilt owner country:
Quilt owner phone number:
○ Open/Public Domain
○ Restricted
For holder of copyright, contact:
I release to the Quilt Index the information recorded on this form, the photos provided with this form, and the related photos taken
by the Quilt Index for the educational and research purposes they deem appropriate.
Signature:
May the staff of the Quilt Index contact you about this quilt?
Date:
 Yes, contact owner
 Yes, contact maker
 No
 Yes, contact:
Contact’s email address:
Notes:
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1
Blythewood Historical Society and Museum
Quilt #:
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Quilt Maker Form
Who made the quilt?
If you are a relative of the quiltmaker, how are you related? The quiltmaker is my:
 Wife
 Grandmother
 Sister
 Unknown but from my family
 Mother
 Great-grandmother
 Aunt
 Unknown but from my spouse’s family
Other relationship:
Quilt top made by:
Other people who worked on this quilt:
Quilted by:
Gender:  Female  Male
 Group
Group’s founding date:
Unique characteristics of the group:
If quilting group, group name:
Group’s ending date:
Quiltmaker’s information
Street address:
City:
County:
State or Province:
Zip Code:
Country:
Quiltmaker’s maiden name:
Birth date:
Birthplace:
Death date:
In which kind of environment did the quiltmaker grow up:  Rural
Ethnic background/tribal affiliation:
 Urban
Educational background:
Religious affiliation:
Occupation:
Father’s name:
Mother’s name:
birthplace:
birthplace:
Marriage date(s):
Spouse’s/spouses’ name(s):
Spouse’s/spouses’ occupation:
 From guild or club member
 From home extension agent
 Under 10 years of age
 Age 11-19
 Age 20-29
Why does/did the quiltmaker quilt:
ethnic/tribal background:
ethnic/tribal background:
Spouse’s/spouses’ ethnic/tribal background:
Number of children:
How did the quiltmaker  From class
learn to quilt:
 From friend
When learned to quilt:
Reservation:
 Church
 Fundraising
 Age 30-39
 Age 40-49
 Age 50 or over
 Gifts
 Income
Estimated number of quilts made by this quilter: ○ 1-5 quilts
Does/did quiltmaker sell quilts: ○ yes ○ no
Does/did quiltmaker teach quilting: ○ yes
○ no
 From relative
 From TV show
 After an illness
 After raising children
 After retiring
 Necessity
 Pleasure
○ 5-20 quilts
 From 4-H extension agent
 Self-taught
 Therapy
Other:
○ 20-50 quilts
○ more than 50
If yes, price charged:
○ only informally
Does (did) the quiltmaker belong to a group (other than the one listed above)?
Name of group:
Location of group:
Specialized activities/events of quilting group:
2
Blythewood Historical Society and Museum
Quilt #:
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Artist statement and/or stories about the artist
Written by:
Date written:
Feel free to attach extra sheets of paper if you need more room.
3
Blythewood Historical Society and Museum
Quilt #:
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Quilt Description Form
Name(s) for quilt’s pattern in common use:
Source of pattern name (Brackman number):
○ Finished quilt
This is a: ○ Quilt top with unfinished edge
○ Quilt blocks or pieces
○ Quilted garment
○ Summer spread
Overall width measurement:
Shape of edge:
○ Straight
Other type of quilt object:
Overall length measurement:
○ Scalloped
○ Sawtooth
○ Rounded
○ T-cutout
○ Embellished or trimmed
Other shape of edge:
Top
 Beige or Tan
 Black
 Blue
Predominate
color(s):
Quilt-specific
colors:
 Brown
 Burgundy
 Cream
 Fuchsia
 Gold
 Gray
 Green
 Lavender
 Maroon
 Bubblegum Pink
 Butterscotch
 Cadet Blue
 Cheddar Orange or Antimony or Chrome Orange
 Chocolate Brown or Hershey Brown
 Chrome Green
 Navy
 Orange
 Pink
 Chrome Yellow
 Claret or Wine
 Double Pink
 Indigo Blue
 Lancaster Blue
 Madder Brown
 Purple
 Red
 Rust
 Turquoise or Teal
 White
 Yellow
 Madder Red or Cinnamon Red
 Madder Orange
 Manganese Bronze
 Nile Green
 Prussian Blue or Lafayette Blue
 Turkey Red
Other color:
Overall color scheme:
Layout format:
 Multi color
 One color/monochromatic
○ Block pattern
○ One patch or allover
○ Crazy
Number of quilt blocks:
 Two color
 Light or pastel colors
○ Medallion or framed center
○ Wholecloth
○ Vertical strip
○ Horizontal strip
○ Pictorial
○ Nontraditional or art
Size of quilt blocks (L x W):
Arrangement of quilt blocks: block orientation:
○ Straight
○ On point, rotated 45 degrees
 Diamonds
 Hexagons
Number of borders:
Fiber types used in quilt top:
○ Other
Medallion size:
○ Rotated, but less than 45 degrees
Describe the spacing relative to other blocks:
 Side by side
 Alternating with plain squares
 Separated by plain sashing
 Separated by sashing with cornerstones or connecting blocks
 Separated by pieced pattern sashing
 Separated by appliqued pattern sashing
Other spacing:
Block style:
 Bright or primary colors
 Dark colors
 Same block throughout
 Sampler
 Separated by garden maze sashing
 Separated by vertical strips
 Separated by horizontal strips
 Separated by floated or random sashing
 Zig zag
Sashing width:
 Squares
 Triangles
Number of different block patterns present:
Border Description:
 Cotton
 Cotton or polyester blend
The Quilt Index: http://www.quiltindex.org/
 Linen
 Polyester
 Rayon
 Silk
 Wool
 Other blends
 Other synthetic
 Unknown
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4
Blythewood Historical Society and Museum
Quilt #:
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Fabric types used in  Broadcloth
quilt top:
 Chintz
Fabric patterns, styles,
motifs, or print categories
used in quilt top:
 Flannel
 Feedsack
 Batiks
 Cheater fabric
 Checked
 Conversation prints
 Dotted
 Feedsack
 Glazed
 Handwoven
 Linsey-woolsey
 Muslin
 Floral
 Geometric
 Hand-dyed
 Mourning prints
 Multiple scrap
 Sateen
 Satin
 Novelty
 Paisley
 Plaid
 Premium type
 Print
 Velvet
 Unknown
 Printed patchwork
 Solid/plain
 Stamped
 Striped
 Unknown
Other fibers or fabrics:
Construction techniques used in quilt top: piecing techniques:
 Hand Piecing
 English Template Piecing  Strip/String Piecing
 Machine Piecing
 Foundation Piecing
 Other piecing
Construction techniques used in quilt top: applique techniques:
 Hand Applique
 Fusible Applique
 Blanket, buttonhole, or other decorative applique stitch
 Machine Applique
 Reverse Applique
 Other appliqué
Construction techniques used in quilt top: novelty techniques:
 Biscuits
 Dimensional applique
 Cathedral Window
 Folding
 Gathering/ruching
 Yo-yo
Construction techniques used in quilt top: embellishment techniques:
 Attachments (beading, charms, buttons, etc.)  Ink drawing
 Embroidery
 Painting
 Other novelty technique
 Photography/photo transfer
 Other embellishment technique
Unique or other construction techniques:
Embellishment materials used in top:
 Beads attached
 Chenille thread
 Buttons attached  Cotton thread
 Charms attached  Metallic thread
 Ribbon thread
 Silk thread
 Synthetic thread
 Wool thread
Unique embellishments:
 Cannot tell
 Other attachments
Batting and quilting
Material used for quilt batting or filling:
○ Cotton
○ Polyester
○ Cotton or polyester blend
○ Wool
Batting loft:
○ Thin
○ Medium
○ Blanket or flannel
○ Sheet
○ Another quilt
○ No filling
○ Cannot tell
○ Other
○ Thick
Unique or other batting:
Quilting techniques used:
 Hand quilting
 Machine quilting
 Quilt as you go
 Tied or tufted
Thread type:
Number of quilting stitches per inch (Place 1):
Width between quilting lines (in inches):
Quilting designs used:
 All-over-design
 Meander/free motion
 Stipple
 Clamshell
 Echo
 Elbow/fan
 Feathering
 Wreaths
 Grid/crosshatch
 Grid diamond
The Quilt Index: http://www.quiltindex.org/
 Stuffed work
 Corded
 Not quilted
Other
Thread color:
(Place 2):
Knots visible:
○ yes
 In-the-ditch
 Outline
 Patches outlined/in the ditch
 Cables
 Floral
○ no
 Vines
 Parallel lines
 Single parallel lines
 Double parallel lines
 Triple parallel lines
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5
Quilt #:
Blythewood Historical Society and Museum
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Other quilting designs used:
Binding
Materials used in quilt binding:  Cotton
Fabric structure used in binding:
 Flannel
 Knit
 Plain weave
 Twill weave
Construction techniques used in binding:
 Separate binding applied
 Front turned to back
 Back turned to front
 Edges turned in/no separate binding
Width of binding:
 Cotton or polyester blend
 Satin
 Sateen
 Unfinished/raw edge
 Bias grain
 Straight grain
 Woven tape
○ less than a half inch
 Linen
 Silk
 Velvet
Other
 Unknown
 Home cut
 Hand sewn
 Machine sewn
 Commercial
○ half inch - one inch
 Wool
 Cording
 Fringe
 Lace
 Prairie points
○ greater than one inch
 Ribbon
 Ruffles
 Other
Other width:
Describe unique binding:
Condition and Repairs
Overall condition: ○ Excellent/like new
Notes on condition or repairs:
○ Very good/almost new ○ Good/moderate use
○ Fair/worn
○ Poor/very worn
Date and Inscriptions
Time period:
○ Pre-1799
○ 1800-1849
○ 1850-1875 ○ 1901-1929
○ 1876-1900 ○ 1930-1949
○ 1950-1975
○ 1976-1999
○ 2000-2025
○ Timepsan
Further information concerning date(s):
Type(s) of inscription:  Signature  Single
Other type(s) or inscription:
Content of inscription(s):
 Multiple names
Method of inscription:
 Attached label
 Embroidery
Other method of inscription:
 Ink
 Pencil
Location of inscription:  multiple locations
 on back
 Initials
 In the quilting
 Stamped
 Date
 Place  Message
 Stencil
 Typewriter
 on block
 on border
 Printed in the fabric
 Computer generated
 other
Back
Fabric fiber types used in quilt back:
 Cotton
 Flannel
 Cotton or polyester blend  Linen
Color of backing:
 Satin/Sateen  Synthetic  Woven or homespun
 Silk
 Wool
 Beige or Tan  Brown
 Fuchsia
 Black
 Burgundy  Gold
 Blue
 Cream
 Gray
Number of pieces in quilt back:
Description of back:
 Back art/design on quilt back
 Different fabrics
 Hand sewn
The Quilt Index: http://www.quiltindex.org/
 Green
 Lavender
 Maroon
 Navy
 Orange
 Pink
Other
 Purple  Turquoise or Teal
 Red
 White
 Rust
 Yellow
Width of pieces:
 Machine sewn
 Print
 Reversible
 Same fabric used throughout
 Solid/plain
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6
Blythewood Historical Society and Museum
Quilt #:
Fill out one form for each quilt
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Any other features or notes about the quilt’s appearance, materials, or construction:
The Quilt Index: http://www.quiltindex.org/
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7