Memorial Service Registration Form

Please let us know who will be attending the service:

Parent and Attendee Information

Contact Information

At Children's, we remember and honor your children during our annual Memorial Service in several ways

  • I allow my child's photo and name to be displayed in a slide-show presentation that will be shown during the Memorial Service.
  • I allow my child's name to be printed in the program that will be handed out to Memorial Service attendees.
  • I allow my child's name to be read aloud during the candle-lighting portion of Children's Memorial Service. If your family is attending the service, you will be invited to read your child's name. If your family is unable to attend the service, your child's name will be read by a Children's staff member.

Photo Upload

If you have chosen to include your child's photo in the 2017 Memorial Service slide-show, please upload the photo here. If you do not have an electronic copy of your child's photo, please contact Bereavement Services at 612-813-7216 for further assistance.

(Max size 10MB)

Information Release Authorization

You have indicated that you would like your child's photo and/or name displayed during the Memorial Service. We will need your permission to do this. By typing your name below, you are giving Children's permission use your child's photo and/or name during the Children's Memorial Service on May 20, 2017.

Finalize and Submit

Please contact Bereavement Services at [email protected] or 612-813-7216 with questions or if you need help with registration.