Family Support Registration

Family Information

Begin your healing journey today by filling out the family registration form. We see you. We care about your broken heart.

Parent's Name

Spouse Name

This address will receive a confirmation email

Phone

Address

Diocese + Parish

Red Bird Ministries collects the information below as data points to where families are coming from. This helps us to articulate the need in your community and advocate on your behalf when bringing in support to a new diocese/parish.

What diocese do you live inside?

What parish do you worship at?

Contact Information

Would you like someone to receive support information on your behalf? If so, please list their name, phone number, and email.

Preferred Contact

Loss Information

The next set of questions will be specifically about your loss. We know this part is the hardest. We are wrapping our arms around you, sister/brother. We love you. We only want to help. Please let us know how we can serve you.

What is the name of your child? If you haven't given your baby a name yet, please just put "Baby" followed by your last name. Example: Baby Breaux

What is your child's date of birth? If pregnancy loss, you may put your date of delivery.

What is your child's date of death? If pregnancy loss, you may put your date of delivery or the date you found out your baby had died.

How old was your child when he/she died? If pregnancy loss, please list the gestation week. Example: 11.5 weeks in utero, or 11.5 weeks.

Would you like your child to be included on the Memorial Wall on our website and in our End-of-the-Year Memorial video?

Yes No

Memorial Wall Photo

Upload (8MB)

Support Services

Would you like to be notified when support is being offered both in-person and virtually. Please check all that applyI would like to:

Join Our Monthly/Quarterly Newsletter Join Our Email Support Updates as posted. I do not want to be emailed about support services.

Would you like to receive the following support offerings. Please check all that apply.

Spiritual Direction Appointment Virtual Comfort Call Recommended Support Offerings Information about bringing Red Bird Ministries to Your Parish No thank you

For counseling referrals, we will send you information to connect with a Catholic provider in your area. For sacrament or clergy referrals, we will share your request with the Nonnatus Foundation whose mission is pastoral accompaniment for families in crisis. They will reach out to schedule an appointment for you to talk with a priest. Please check all that apply.

Catholic Counselor Schedule a Call With Clergy No thank you.

From all of us at Red Bird Ministries

Thank you for trusting Red Bird Ministries to serve your family during this season of immense suffering. We are honored to walk with you during this time. Our team will be in touch with you via email within 24-48 hours.

This support offering is completely free of charge to your family. However, if you feel called to help financially support the work we do for families like yours and ours, you can donate below. If you want to give more, please reach out to us at hello@redbird.love, and someone will be in touch.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Family Support Registration

Description

Please Fix the Following