Memorial Service Registration Form

* Name of child(ren) to be remembered (Please write your child's name the way you would like it to be displayed during the Memorial Service):

Please let us know who will be attending the service:

I/We will attend the memorial service

I/We are unable to attend the memorial service, but would still like to have our child(ren) remembered during the service

Parent and Attendee Information

* Names of parent(s)/guardian(s) attending:

Names of other adults attending:

Names/ ages of children attending:

Contact Information

* Daytime phone:

* Email Address:

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

By clicking this button I give permission for my child(ren) to be remembered during the 2024 Children's Memorial Service in ALL 3 of the following 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.

By clicking this button I am stating that I only want my child(ren) to be remembered in 1 or 2 of the standard three ways.

By clicking this button I am stating that I plan to attend the 2024 Memorial Service as a guest. I DO NOT want my child's photo or name displayed in any way. I also WILL NOT be reading my child's name aloud during the candle-lighting portion of the service.

Photo Upload

If you have chosen to include your child's photo in the 2024 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.

Upload a Photo (Max size 10MB - JPG, BMP or PNG)

Information Release Authorization

You have indicated that you would like your child's photo and/or name displayed or read 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 11, 2024. *

* Online signature (first and last name) for release of photo/information: