LRF Funeral Funding Application

Funeral Funding Application

We are so incredibly sorry you are here. Know that you are not alone and that we will do everything we can to ease the financial burden of child loss for you. Please apply below for assistance. Note: payouts are made directly to the funeral home to cover funeral expenses only.
Parent's Name
Mailing Address (sometimes we send families gifts 💕)

Street Address Line 2
Email
Phone Number
Child's Name
Child's DOB

MonthDayYear
Child's DOD

MonthDayYear
Diagnosis
Funeral Home Name
Funeral Home Address

Street Address Line 2
Funeral Home Email
Funeral Home Phone Number
Funeral Type

BurialCremation
Service Date

MonthDayYear
Estimated Funeral Expense
Please verify that you are human*
Are there any specific verses or words that you would like shared about your sweet one? Please add them below so we can share them with their picture (if applicable) for the listing on their donation link.
Do you give Lillian Rose Foundation permission to share your child’s photo and/or verse/quote on social media along with their link so our followers can help with donations?

YesNo
If you would like, you are welcome to upload a photo of your child for us to share with their fundraiser listing on our website and on social if you would like.

Cancelof
Should be Empty: