Support To Honor Your Baby

Our 501(c)(3) nonprofit, The No Fear Foundation, was created to support families like yours. "Sorry" does not feel like a strong enough word to say for the pain you're experiencing. There really are no words to fully piece together for what you're going through and our hearts are with you during this unimaginable time. You are not alone. We are here to walk alongside you, support you however we can and stand with you as you grieve. Please complete the information below so we can best serve you and honor your baby, who is deeply loved and is immeasurably missed.

First name

Last name

What city and state do you live?

Phone

By checking this box, I agree to receive text messages from our Executive Director to organize support efforts.

Baby's Date of Birth:

Month

Day

Year

Baby's Welcome Into Heaven Date:

Month

Day

Year

NICU Hospital:

Can you please describe your baby's medical condition:

Do you need assistance paying for cremation/burial or funeral expenses?

Yes

No

Do you have health insurance?

Yes

No

If yes, who is your insurance provider?

Are you interested in speaking to one of our grief counselors?

Yes

No

Are you interested in a memorial sweatshirt made from a piece of your baby's clothing or blanket? (We provide these free of charge.)

Yes

No

If we can meet one need right now that would alleviate stress, what would it be? (Nothing is off the table!)

Do you speak English? (This helps determine if we need a translator for communications.)

Yes

No

I declare that the info I’ve provided is accurate and complete.

Signature:

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