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Pediatric memorial service registration

Thank you for your interest in the pediatric memorial service, this year presented as an interactive virtual event. We look forward to honoring your child.

Please complete the form below to register for this event by April 23. We will send you more information about the service, including links to the virtual event as well as service materials and keepsakes.

Your name  *Name of child(ren) you are honoring  *Email
We need a valid email address to send you a secure link to the service. 
Street address
We request your mailing address so we can share service materials with you. 
City/State/Zip code  *Service you plan to attend  *How many people do you think will participate in the service with you?
(You may share the link you receive with family and friends, or invite them to register) 
We ordinarily send invitations to this service for 2 years after a child's death. If you would like to remain on our list beyond 2 years, please check the box below. Please let us know of any questions or requests you have and we will get back to you as soon as possible. You may also call 804-828-1545 or email, especially if you have photos/images you want to be shared during the service.