Lillian Rose Foundation Angel Box Form

Angel Box Program
Your Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
Phone Number *
What is your child's name? *
Is your child a boy or a girl? *

Boy Girl
What is your child's birth date? *

Month Day Year
What day is their "angelversary"? *

Month Day Year
This is the day they went to heaven!
What did they weigh at birth? *
Lils was 4lbs 12oz
What are some things that remind you of your angel or things you love about them? *
Things that remind me of Lils are flowers, butterflies, unicorns, the color pink, etc. to list some examples!
We love making items for our packages with photos of your babe! Add your favorite photo here.
Thank you so much for submitting this form for an angel box. We know your sweet one is so proud of you and loves you so very much. We cannot wait to create something beautiful for you to always have them close!
Should be Empty:

Angel Box Program