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.
* Required
Email address
*
Your email
Sent from (your name)
*
Your answer
Do you want the box to say it was requested by you?
*
Yes
No, I'd rather stay anonymous
Child's Name
*
Your answer
Type of Loss
*
Pregnancy/Infant Loss
Sudden Death
Medical Conditions
Other:
Date of Birth/ Date of loss
Your answer
Name of Family to Send Angel Box to:
*
Your answer
Family's Address
*
Your answer
Number of additional children in the family. (please include ages if possible)
*
Your answer
A copy of your responses will be emailed to the address you provided.
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