Burial Assistance Form - The Unforgettables Foundation

Please note: We help families residing in San Bernardino County, Riverside County and Orange County for children within age range of 22 weeks gestation to 18 years of age.

Please have mortuary/crematory send contract to info@theunforgettables.com after your application has been submitted. We cannot process your form unless contract from mortuary/crematory is received.

*All fields below must be filled out. Please put n/a or unknown in a box if you are unsure.

Date

Name of Child

Age

Date of Birth

Date of Death

Full Term?

Yes No

How many weeks gestation?

Cause of Death

Location

Parent's Names

Address

City

Zip Code

Phone

SSN

Place of Employment

Email Address

Referred by

Reason for Assistance

Mortuary / Crematorium

Address

City

Zip Code

Phone

Contact

Date of Service

Other minor children in the home? Please list names and ages.

Submitted By

I certify that the above is true and correct. I understand that a copy of my contract will be shared with The Unforgettables Foundation (TUF), and that my family’s name may be used by TUF.

Thank you for your application. You will be notified via email once processed. Please allow 24 hours for review. All applications submitted on Friday after 12pm through Sunday will be reviewed on the following Tuesday.

Upon approval, checks will be mailed directly to the mortuary/crematory.