Request Financial Assistance | Luna Babies Foundation

Your application is encrypted the moment you submit it and is never emailed in the clear. Fields marked * are required.

Language

Preferred language

Prefer to apply in Spanish? Email admin@lunababies.org and we’ll help you directly.

Your baby

Baby’s first name *

Baby’s last name *

Date of birth *

Date of passing *

If pregnancy related, how many weeks?

Cause of loss (for our records)

Baby’s ethnicity (optional, statistical only)

Parent / guardian

First name *

Last name *

Phone *

Street address *

City *

State *

ZIP *

Second parent / guardian (optional)

First name

Last name

Phone

Mortuary

Mortuary name *

Mortuary address

City

State

ZIP

Mortuary phone *

Have you met with the mortuary? *

Service selected

Final mortuary estimate

Household income (for our records only)

Stay connected (optional)

Add my baby to the Butterfly Remembrance Garden Send me email updates Facebook support group access Connect me with grief support

Finishing up

Your first name *

Your last name *

If you don’t hear back within 24 hours, email admin@lunababies.org.

Request Assistance