Thank you for requesting that a candle be placed for your angel on our "Candles of Love" pages.

To submit a request please complete the form below and then click on the "submit" button when you are ready to send the information. Please complete all sections of the form so that the information is complete.

As this site, the web space and time put into it are all given by donation / volunteers, please request only one candle per child.

There is no charge for the candles, or any other part of this website. If you wish to make a donation towards the costs of maintaining this site feel free to use the secure donation button at the bottom of the page. Alternatively you could click on any of the advertisements at the bottom of the page. The income generated from these advertisements is solely used towards the costs associated with this web site.

Only that information which you submit about your angel shall be used for the candle.

Please include your email address on the form. It will not be placed with the candle, neither will it be given or sold to any group or individual. Your email address will only be used to contact you regarding your candle. For example you will be emailed when the candle is placed so that you can check that all the details are correct.  

 

Your name: e.g. Jane Smith
Email address:
Name of the person who the candle is for:
Date of Birth: (dd/mm/yyyy)
Date of Death: (dd/mm/yyyy)
Was your child stillborn? Yes
No
Diagnosis: e.g. Trisomy 18
Town:
State:
Country:
Signature:

e.g. Loved daughter of Peter and Jane

 
Any comments that you wish placed with the candle? For example a short poem or special message of 3 or 4 lines to be included with the candle.
Would you like to subscribe to the Wings  List, and email based support group for those who have lost a child? Yes
No
   
 
 

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Visitors Since 14th May 1999 


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This page was last updated 22nd October 2005