Angel Box Request
Please fill out the request form completely.  We will send the family an Angel Box once all information is submitted. We try to customize our Angel box in relation to the type of loss, and to have something for all members of the immediate family.  Our boxes are intended to be sent out with a delay to avoid the "busy" period immediately after the loss. If you wish to assist with covering the costs of an Angel Box- please refer to Sponsor an Angel Box on our website or check out our Amazon Wish list.

Thank you for your submission for an Angel Box Request and allowing us to Honor another Child gone too soon.

HONOR HOPE HEAL
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Email *
Sent from (your name) *
Do you want the box to say it was requested by you? *
Child's Name *
What is the gender of the child?
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Type of Loss *
Pregnancy/infant loss only. Please include how many weeks gestation if applicable.
Medical Conditions only. Please include a brief description on the type of medical condition. Example- Rare Disease, Cancer, Chromosome abnormality.
Date of Birth/ Date of loss
Name of Family to Send Angel Box to: *
Address the Angel Box should be sent to. (please include city, State, Zipcode) *
Number of additional children in the family. (please include ages if possible) *
A copy of your responses will be emailed to the address you provided.
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