A Program of the North Simcoe Muskoka Hospice Palliative Care Network
Your Name (required)
Your Email (required)
Your Loved Ones Name
Will you be attending the in person ceremony on November 30th?
If yes, will you be bringing a guest?
Would you like a special message added to the Memorial Wall which will be displayed on the Hospice Orillia website until November 2024?
Is your memorial for a baby or pregnancy?NoYes
If you would like a photo of your loved one to be included on the memorial wall, please attach a photo. This photo may include your loved one (no group photos please). You can attach up to 1MB jpg, eps, png or pdf file. Should you have any difficulties attaching your photo, please email firstname.lastname@example.org for assistance.
By checking below:
You provide Hospice Orillia permission to share your loved ones name and/or photo during the Candles Remembrance ceremony and on the Hospice Orillia website, and the Hospice Orillia Facebook page.
Would you like to receive a copy of the Hospice Orillia monthly newsletter sent directly to your email address?YesNo