Service Attendance RSVP

UVA Health Children's Service of Remembrance celebrates the lives of children, their courage, and the love they shared with their families and staff.

This year, the service will be held virtually. Join us on October 19, 2024, at 12 p.m. to attend the Service of Remembrance.

Submit your remarks here for sharing during the service. Please submit your remarks no later than October 5, 2024.

Child's name

Please provide the whole name of the child whom you will be honoring: first, middle, last.

Number of adults attending

(including yourself)

Number of children attending

Will you need childcare?

Yes

No

How many children will require childcare?

If you answered yes, list the ages of the children who will need care.

Number of wheelchair-accessible seats needed

Would you like to speak?

Yes

No

Maybe - please contact me with more information

Let us know if you would like 2-3 minutes to speak during the family reflection time of the service.

Do you need interpretation services?

Yes

No

If yes, what language do you need services for?

Will you attend next year?

Yes

No

Let us know if you would like to be invited again next year.

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

If you would like to be added to the mailing list and invited again next year, provide your full mailing address.

Your contact info

Provide an email or phone number.

Questions or comments

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