Bereaved Families of Ontario - Durham Region

If you would like to remember your child on this page, please complete the short form below.

Our Children Remembered

First Name(*)

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Last Name(*)

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Amount of OUR CHILDREN REMEMBERED Donation Pledged(*)

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Street Address(*)

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Unit number(*)

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Town/City(*)

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Province/Territory(*)

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Postal Code(*)

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Phone Number(*)

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e-mail address(*)

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Message

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Name of Child(*)

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Photo of Child

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Special graphics request (eg. heart, dog, flower, etc.)(*)

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