Memorial Service Registration Form

About Children’s Minnesota Memorial Service

Children’s Minnesota Memorial Service is a beautiful and meaningful event where families have the opportunity to remember and honor their children who have died. Parents, siblings, extended family and close friends are all welcome.

Event information

Sunday, May 4, 2025 | 1:30–3 p.m.
The Chalet at Hyland Hills
Bloomington, MN
Registration for this event is now closed.

For more information

For questions or more information, please contact Bereavement Services at [email protected] or 612-813-7216.

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

The information below is needed for nametags and childcare purposes.

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

Names of other adults attending:

Names/ages of children attending:

Contact Information

Daytime phone:

Email Address:

Please include my child's information in the 2025 Children's Memorial Service

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

By clicking the options below, I give permission for my child(ren) to be remembered during the 2025 Children's Memorial Service in the ways selected:

I allow my child's photo and name to be displayed in a slideshow 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.

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 Minnesota permission to use your child's photo and/or name during the Children's Memorial Service on May 4, 2025.

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

Photo

If you have chosen to include your child's photo in the 2025 Memorial Service slideshow, we will contact you with information about submitting a photo.

Do not include my child's information in the 2025 Children's Memorial Service

Please do not include my child's information in the 2025 Memorial Service:

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.

Finalize and submit

Do you need an interpreter?

Yes

If yes, for what language?

If you selected "other", please list the language:

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

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