Application & Resources -

Personal Information

First Name *

Last Name *

Child's Name *If Unknown please write Unknown

Child's Date of Birth *

Child's Date of Death *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Phone *

Email Address *

Death Certificate

No file chosen

Upload if Death Certificate was issued.

Funeral Home Information

Funeral Home Name *

First Name *

Last Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Phone *

Email Address *

Website

Invoice Upload

Please upload any invoices you have received.

I understand that I am giving Mothers of Angel Babies permission to inquire about my financial situation with the Funeral Home listed in this application. I understand I will have to provide a death certificate if one was issued. I also understand that I nor the Funeral Home can hold Mothers of Angel Babies legally responsible for total payment and that Mothers of Angel Babies services is donation to help financially with funeral services. Payments will be directly paid to the funeral home. *Yes

Signature *

Resources

The Audrey & McKenna Foundation – Cremation boxes
- Age: gestation up to 5 years old
- Time: within the last 6 months
- Cost: free by generous donors
- Where: http://www.Facebook.com/AudreyAndMcKenna
- Contact: AudreyAndMcKennafoundation@gmail.com