Annual Remembrance Service Submission Form 2026
Please complete the form below to participate in the Frederick Health Annual Remembrance Service photomontage. This event is being held on Thursday, December 3, 2026 at 7:00pm at Monocacy Valley Church 9861 Old National Pike Ijamsville, MD 21754.
Please note: if you have had multiple losses, you can submit more than one form for each person you lost.
Your First Name
*
Your Last Name
*
Your Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
First Name of the Person in Your Photograph (deceased)
*
Middle Name or Initial of the Person in Your Photograph (optional)
Last Name of the Person in Your Photograph (deceased)
*
Your Relationship to the Person in the Photograph
*
ie: child, parent, sibling, spouse, aunt/uncle, cousin, friend
DATE OF BIRTH of the Person in Photograph (Month, Day, Year)
*
-
Month
-
Day
Year
Date
DATE OF DEATH of the Person in the Photograph (Month, Day, Year)
*
-
Month
-
Day
Year
Date
List up to Five Things Your Loved One Enjoyed (For example: Fishing, Baking, Dogs, Traveling)
*
Attach the Photograph of Your Loved One for the Slideshow
*
Upload Photo
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: