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 June 16th?
Would you like a special message displayed during the virtual ceremony that will be released after the ceremony?
Is your memorial for a baby or pregnancy?NoYes
If you would like a photo of your loved one to be included in the virtual program, which will be released one week following the live ceremony, 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
Would you like to order a copy of the Garden of Remembrance program?:
If YES, please provide address for delivery:
By checking below:
You provide Hospice Orillia permission to share your loved ones name and/or photo during the Garden of Remembrance ceremony on the Hospice Orillia website, the Hospice Orillia Facebook page and the NSMHPCN YouTube channel.You provide Hospice Orillia permission to use your loved ones name and/or photo to increase awareness of the Garden of Remembrance.