Honor the Memory of Your Child

Add Your Child to Our Memorial Wall

We remember and celebrate the lives of children who have bravely gone before us. Please complete the form below and we will add your child to our Memorial Wall.

Your Information

First Name

Last Name

Your Relationship to Child

Child's Information

Child's First Name

Child's Last Name

Type of Diagnosis

Date of Diagnosis

Child's Date of Birth

Date of Passing

Child's Image

One file only.
100 MB limit.
Allowed types: gif jpg jpeg png.

I give permission to use child’s image in the sunflower field and the Prayer’s From Maria database.

Child's Family Information

Mother's First Name

Mother's Last Name

Father's First Name

Father's Last Name

Family Email Address

Address Line 1

Address Line 2

City

State

Zip

Additional Information

Is there any other information you would like to share with us?

CAPTCHA

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