Perinatal Memorial Service Registration Form

Please let us know who will be attending the service:

Parent and Attendee Information

Contact Information

Please choose ways you wish your child to be remembered during the service:

Information Release Authorization

By typing your name below you are giving Children's permission use your child's name during the Perinatal Memorial Service on October 15, 2016.

Finalize and Submit

Please call 612-813-7216 with questions or if you need help with registration.