Cremation Box Application
We are so sorry for your loss. Please know that our thoughts and prayers are with you as you go through this difficult season. Fill out the form below if you are the parent of a baby/young child who has passed in the last six months. We receive hundreds of requests every day for cremation boxes and try to make as many as we can to help families heal and grieve. If you are selected to receive a cremation box, we will reach out to you by email. Thanks!
Name *
Relationship to baby/babies you are requesting a cremation box for *
Address *
Email *
Your baby/babies' name(s) *
When were your baby/babies born? *
MM
/
DD
/
YYYY
When did your baby/babies pass? *
MM
/
DD
/
YYYY
What hospital (city and state) were your baby/babies born or being care for? *
Please share a little bit about you/your baby and why you are requesting a cremation box. *
Was your baby cremated? *
Are the baby/babies you are requesting a cremation box for 5 years old or younger? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy