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Request a Dedication

Please fill out the form to request your dedication. Thankyou.

Dedications on this site are free though donations through our online shop are welcome and will help us maintain our free service for bereaved children.
See our website for Childhood Grief

* Required

* First Name:
(of the person you are making the dedication to)

* Last Name of the person:

* The Relationship of this person to you:

* Your Name:

* Your Dedication Message/Story:

If you would like your email address displayed on your dedication please enter it here:

Please choose a Background:

Plain White Background
Together again one day
Together again one day

Ray of Light
Ray of Light
Footprints in the sand
Footprints in the Sand
Beautiful Butterfly
Beautiful Butterfly
Winter Landscape
Winter Landscape
Fury Friend
Furry Friend
I picked a flower for you today
I picked a flower for you today

Please choose a song:
(Click on the song title to hear a preview)
Bridge over Troubled Water - Simon & Garfunkel
Wonderful World - Lois Armstrong
Imagine- John Lennon
Tears In Heaven - Eric Clapton
China Roses - Enya
Evening Falls - Enya
Lothorien - Enya
The Sun In The Stream - Enya
Wind Beneath My Wings - Bette Midler
Mull of Kintyre - Paul McCartney
Bright Eyes
Hero - Maria Carey
Ave Maria
Dont Dream Its Over - Crowed House
Somewhere Out There
You Are So Beautiful - Joe Cocker
Cursum Perficio - Enya
Fairytale - Enya
Marble Halls - Enya
Watermark - Enya
The Rose - Bette Midler
Amazing Grace
Special Requests:
Any particular colours, graphics, a specific background not shown above, etc). We will try our best to accommodate your request.
If you have any pictures or additional items you would like on the dedication page, click here and send as attachments. Note: Limit total size of attachments to 2MB.

Your Email Address:
(This will NOT be published but is required so that we can confirm your request for this dedication)

Security Image:
Type the text from this image into the box below.
Captcha Image: you will need to recognize the text in it.
Use capital letters and numbers only


Central Coast Websites
Bereavement Care Centre Home Page A Friend's Place - Click Here to go to www.childhoodgrief.org.au website