Commemorative Care

We are thankful to be connecting with you. We want to help commemorate your child alongside you - answering these questions will help us do that. We understand that every family story is different and unique, therefore not all questions will apply to all families.

Child's Name

Mother

First Name

Last Name

Father

First Name

Last Name

Guardian (If Different than Mother/Father)

First Name

Last Name

Mother's Phone Number

(###)

###

####

Father's Phone Number

(###)

###

####

Names and Ages of Child's Siblings

Mother's Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father's Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Email

Father's Email

Child's Date of Birth

YYYY

Child's Date of Death

YYYY

Would you like your child's story to be featured on our social media platforms?

This would be used a way to celebrate your child’s life and to encourage other families experiencing grief associated with the death of a child.

The following are not required questions, but will help us as we seek to honor your child. Answer any or all questions that feel the most appropriate.

What three words would you use to describe your child?

What is your child's favorite place to visit?

What is your child's favorite book?

What is your child's favorite color?

What is a favorite memory you have with your child?

Anything else you would like to share about your child?

Commemorative Care

The Magnolia Foundation900 S. Willow Ave.PO Box #2252Cookeville, TN 38502

The Magnolia Foundation
900 S. Willow Ave.
PO Box #2252
Cookeville, TN 38502