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Memory Day booking form
Memory Day booking
If you would like to attend one of our 2024 Memory Days, please complete the form below. The deadline for submitting information through this form for guaranteed inclusion is Monday 13 May.
"
*
" indicates required fields
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old Contact name
Date you would like to attend
*
Friday 14 June – Shooting Star House
Thursday 20 June – Christopher’s
Please select one date
Contact Name
*
First
Last
Email
*
Phone
*
We have space for up to 6 family members to attend (this can include grandparents). If you are attending without other family members and would like to bring a friend to support you, please include their name below.
Full name of family member 1 and DOB (if under 18)
Full name of family member 2 and DOB (if under 18)
Full name of family member 3 and DOB (if under 18)
Full name of family member 4 and DOB (if under 18)
Full name of family member 5 and DOB (if under 18)
Full name of family member 6 and DOB (if under 18)
Star or Leaf
Would you like to request a Star or Leaf engraved with your child's name?
*
Yes – a star to place Shooting Star House on Memory Day
Yes – a star to place at Shooting Star House on a different date
Yes – a leaf to place at Christopher’s on Memory Day
Yes – a leaf to place at Christopher’s on a different date
No – I already have one
No – I wouldn’t like one yet
If you would like to visit a star or leaf already in place, or to place a newly ordered star or leaf on a different date, please email familysupport@shootingstar.org.uk to arrange a date.
Please type your child’s forename and surname as you would like them to be engraved accurately on their star or leaf
*
Memory Book
Would you like a page dedicated to your child in the Memory Book?
*
Yes – a page to create ourselves
Yes – a page illustrated for my child by an artist – You can talk to an artist at Memory Day and explain how you would like this to look.
No – I already have one
No – I wouldn’t like one yet
Your child’s dedicated page will feature in the Memory Book at the same hospice as your star or leaf.
See some
examples
of how your child’s page could be decorated.
Please upload a photo you would like included on your child's dedicated page in the Memory Book
*
You are only able to upload Jpg, PGN or TIF files through this uploader – if you have other types of file or videos, please contact press@shootingstar.org.uk to arrange another way of transferring them.
Accepted file types: jpg, png, tif, Max. file size: 5 MB.
Memory Video
At Memory Day we will play a video with photos of the children from all the families who are attending. This is optional, if you would like to be involved you will need to share some photos and suggest a piece of music if you have one.
Would you like your child to be included in the memory video
*
Yes
No
Upload 4-8 photos of your child to include in the video montage that will be shared in the service.(Required to submit form)
*
Drop files here or
Select files
Accepted file types: jpg, png, tif, Max. file size: 5 MB, Max. files: 8.
What music would you like to play with your photos:
I would like to use a specific piece of music
I am happy for you to to choose suitable music
Please provide a YouTube link to the song/piece of music of your choice – a short section of which will be played when your child’s photos are being shown.
*
Each year we use a version of the Memory Day video at some of our key fundraising events, such as our annual ball. It shows our major fundraisers how important their support is, in a way that words never can. If you would be happy for your child's photos to be included, please give your consent here.
Each year we use a version of the Memory Day video at some of our key fundraising events, such as our annual ball. It shows our major fundraisers how important their support is, in a way that words never can. If you would be happy for your child’s photos to be included, please give your consent here.
I am happy for my child’s photos to be used at these events
Do you or any of your guests have any dietary requirements?
*
Yes
No
Dietary requirements
*
If you have any other comments or questions about Memory Day please add them here: