Hospice Service of Remembrance

I would like to reserve a spot for the Service of Remembrance virtual gathering on May 20.

I give consent to have my loved one’s name shared in the pre-recorded Service of Remembrance video.

I consent and would like to include a photo of my loved one to be shown in the video.

I would like a link to the pre-recorded Service of Remembrance video to watch on my own time.

By consenting to the above, you acknowledge:

If you consent to share your loved one's name and/or photo, you understand that the name and/or photo may be heard or seen by others who attend the Service of Remembrance virtual gathering and/or who receive a link to view the pre-recorded video.
You give permission for a representative of Hennepin Healthcare to contact you about your reservation and media pieces with the contact information you provide.
You are 18 years of age or older.

Contact Information

Your Name *

Email (we will use this email to register you) *

Phone *

If you give consent to share your loved one's name in our video, please provide their name. (This name does not need to be their full name—for example, you may use a first name or nickname.)

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Service of Remembrance

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Contact Information

Thank you for your submission.