Remembering Canadians lost to COVID-19
HuffPost Canada is gathering the stories of Canadians who died from COVID-19, to help remember their lives and honour their memory.

By filling out this form, you agree to allow HuffPost Canada to contact you, and/or use your responses in a story. Responses may be edited for clarity and/or brevity.
Your name: *
Age:
Phone number:
Email address: *
Your loved one's name: *
Your relation to them: *
Their age:
Their location: *
The date they passed away:
Remembered by (names of family and loved ones):
What would you like your loved one to be remembered for? *
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This form was created inside of Verizon Media.