Refer a Family

Do you know a family who has recently experienced the tragedy of infant loss? We want to help. Hadleigh’s Halo can assist with funeral expenses or delivery of a care package to the family in need. Although we are working to assist as many families as we can, at this time we are limited in the number of families we can support. Please complete the form below to request assistance.

COUNTIES SERVED | Blackford, Delaware, Grant, Jay & Wells

Family Form

*Please know we are only able to serve families in the following counties: Blackford, Delaware, Grant, Jay & Wells.

Name(s) of Parent(s) or Guardian(s)

Please enter the first and last names of the parent(s) or legal guardian(s)

First Name

Last Name

Name of Infant

Please enter the first and last name of the infant who has passed away.

First Name

Last Name

Family's Address

Please provide the best address to reach the family

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Provide the best phone number to reach out to the family

(###)

###

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Obituary

Please include the website link for the obituary

Choice of Assistance

How can we help the family?

Funeral/Arrangement Contributions

Care Basket

Other

Additional Assistance Information

If you selected funeral contributions, please include the location and date of the service. If you selected other, please use this area to share how else we can support the family.

About the Family

We welcome you to use this space however you feel necessary. You can share more about the family, a special memory or even how this support could help.

Your Name

Please provide your first and last name. If you wish to stay anonymous to the family, we will keep your name private.

First Name

Last Name

Your Email

Please provide your email in case we need to reach out to you for additional information.