Cremation Assistance Application

Cremation Assistance Program funded in part by the Eleanor Hutchinson Parker Foundation

Cremation Assistance Application Guidelines

Empty Cradle pays the funeral home and/or cemetery directly and we ask that funds are not passed through to the family; there must be an outstanding balance in order to receive assistance.

Baby must be one (1) year old or younger
$200 towards cremation costs only
Assistance limited to San Diego County and Riverside County area parents. Families in surrounding areas maybe considered with board approval
Completely fill out Application for Assistance below
Email or upload an itemized statement of services rendered from the funeral home
Empty Cradle does not pay for funeral expenses, airfare, obituary postings, containers, or other extraordinary items. Assistance is for cremation services ONLY.
Requests can also be made via mail or email. Please read the Cremation Guidelines and Instructions and print and submit the Cremation Assistance Application

Cremation Assistance Guidelines and Instructions

Cremation Assistance Application

Request for Financial Assistance for Cremation Services

Date of Services

Please Choose the Date of Services

Baby's Full Name

Please Enter Your Baby's Full Name

City & State of Residence

Please add your City & State of Residence

Baby's Sex

Male

Female

Unknown

Please Choose The Sex of Your Baby

Birth Date

Please Enter Your Baby's Birth Date

Birth Time

Please Enter Your Baby's Birth Time

Death Date

Please Enter Your Baby's Death Date

Death Time

Please Enter Your Baby's Death Time

Was Your Baby Full Term?

No

Yes

Was Your Baby Full Term?

Weeks of Gestation

Please Choose The Weeks of Gestation

Age at Time of Death

Please Choose The Age of Your Baby at Time of Death

If Your Baby is a Multiple, Will They Be Cremated Together or Separately?

Together

Separately

Invalid Input

Cause(s) of Death:

Please Choose at least One Option

(Other) List Specifics If Known

PLease Let Us Know Specifics if Known

Servicing Hospital / Medical Examiner

Please Let Us Know the Servicing Hospital & Medical Examiner

List Any Fundraising Page Links

Please List Any Fundraising Page Links, If None, Put "None"

Current Amount Raised

Please Let Us Know The Current Amount Raised From All Fundraisers

How Will The Funds Raised Be Spent?

Please Let Us Know How The Funds Raised Be Spent?

Baby’s Ethnicity for Statistical Purposes

Please Choose Your Baby’s Ethnicity for Statistical Purposes

(Other) Baby’s Ethnicity

Please Let Us Know Your Baby’s Ethnicity

Mother’s Full Name

Please Enter The Mother’s Full Name

Mother's Birthday

/ / Please Let Us Know The Mother's Birthday

Mother's Email Address

Please Enter The Mother's Email Address

Mother's Address

Please Enter Your Address

Mother's City

Please Enter Your City

Mother's State

Please Enter Your State or Province

Mother's Zip Code

Please Enter your US Zip Code (If Outside The US, Put 12345)

Mother's Country

Please Enter Your Country

Mother's Home Phone Number

Enter The Mother's Home Phone Number

Mother's Cell Phone Number

Enter The Mother's Cell Phone Number

Mother's Income

Enter The Mother's Income

Mother's Income Type

Annually

Monthly

Weekly

Hourly

Enter The Mother's Income Type

Mother's Employer

Enter The Mother's Employer

Mother's Employer Phone Number

Please Enter The Mother's Employer Phone Number

Father's Full Name

Invalid Input

Father's Email Address

Please Enter a Valid Email Address

Father's Home Phone Number

Invalid Input

Father's Cell Phone Number

Invalid Input

Father's Birthday

/ / Please Let Us Know The Father's Birthday

Father's Address

Invalid Input

Father's City

Invalid Input

Father's State

Invalid Input

Father's Zip Code

Invalid Input

Father's Country

Invalid Input

Father's Income

Invalid Input

Father's Income Type

Annually

Monthly

Weekly

Hourly

Invalid Input

Father's Employer

Invalid Input

Father's Employer Phone Number

Please Enter a Valid Phone Number

Annual Household Income (Include ALL Contributing Adults In Your Household)

Please Choose

Names & Ages of Children in Home

Please Let Us Know The Names & Ages of Children in Home. If None Put "None"

How Did You Hear About Empty Cradle?

Please Let Us Know How You Heard About Empty Cradle

By submitted this application, I verify that all the above information is true and I understand that the maximum amount for assistance is $200 (USD).

This is a need-based application and to be used when all other options are exhausted. Please review this list for other resources that may be available to assist with your baby’s cremation expenses. Empty Cradle expects each of these areas to be explored prior to applying for assistance through Empty Cradle: State assistance, tribal affiliation, religious affiliation, hospital foundation, family or friends, military dependent, personal savings/credit card, GoFundMe or other fundraising page.

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Please Verify If You Are A Human

Pregnancy and Infant Loss Support, Education & Remembrance

Cremation Assistance Application

Cremation Assistance Application Guidelines

Request for Financial Assistance for Cremation Services

Please Complete All Required Fields Below