Memorial Etching Form

Memorial Etching Form

We are deeply sorry for the loss of your precious child
Note: Memorial etching is offered to those who are unable to bury their child. If you are burying your child in the Lily's Hope section of the cemetery please go back to the website and fill out the "burial form"
Are you a member of the New Rockford community?*

YesNo
I am a parent of the baby to be remembered*

Yes (skip next 3 questions)If no, please answer the next 3 questions
1. If you are not the parent, what is your relation to the baby?
2. Your Name

First NameLast Name
3. I have permission of the baby's parent(s) to remember their child on the memorial stone.

YesNo
Parent of deceased child*

First NameLast Name
Parent of deceased child

First NameLast Name
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Email*
example@example.com
Your Phone Number*

Area CodePhone Number
How do you prefer to be contacted?*

EmailPhone callTxt message
Name & Date to be etched on memorial stone (27 character limit)
examples (but not limited to): Lily Jean Steele 2019, Baby Steele 6-2019, Baby Girl 6-14-19
If you would rather not use a name and date on your baby's memorial line you may enter in the lines above what you would like written to remember your baby. Note: After submission, it must be approved by Lily's Hope Ministry.

Example (but not limited to):

a) Our dear child 2019

b) My sweet baby 2019

c) You are not forgotten '19
If you would like to have a memorial service or funeral with a clergy member, please contact your priest or pastor. If you do not have a christian minister that you are affliated with, but would like to contact one; Pastor Mindy Meier can be reached at 701-625-1544. If you would like assistance with this Lily's Hope desires to assist you.

To keep costs minimal, etching is done once a year.

If you have questions regarding any of the above information, please do not hesitate to contact Lily's Hope Ministry.
I am able and want to contribute the $50 suggested donation*

YesNo
Please mail the $50 suggested donation to Lily's Hope Ministry or donate online: www.lilyshopeministry.com
Lily's Hope Ministry

c/o T. Steele

1750 67th Ave NE

New Rockford, ND 58356
Please make checks payable to: Lily's Hope Ministry
I have read and understand the above information.*

Yes
All information is for Lily's Hope Ministry only, it is confidental and will not be shared.
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