Perinatal Memorial Service Registration Form

Co-hosted by Allina Health / Children's Minnesota


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 Allina Health / Children's permission to use your child's name during the Perinatal Memorial Service on Saturday, October 7, 2017.

Finalize and Submit

Please contact the Allina Health Perinatal Memorial Service planning team with any questions about the Memorial Service, or if you need help with registration. E-mail at [email protected]