landon's legacy retreat scholarship application

Given name(s) *
Given name(s)
Phone *
Phone
My child's name *
My child's name
Date of child's birth *
Date of child's birth
Date of loss *
Date of loss
Please tell us about your child(ren) that you lost. Feel free to include as much or as little as you would like:
(Eg. volunteering, fundraising, awareness, etc)
(Eg: "I'm a compassionate listener.." "I have experience in.." Brag a little!)
(Eg: unable to work, single income family, medical expenses, living children to support etc.)
Part 2 - (please have a close friend or family member fill this portion out)
Friend or family member name *
Friend or family member name
Phone *
Phone