Apply for a Free Casket or Urn

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To qualify for our free casket/urn program:

You must be the parent of the deceased baby to fill out this form.

You must prove financial need: Fill out our application form and send proof of financial need.

You must be willing to write a thank you note to our donor family that explains your situation in two paragraphs or more. These donating families are trusting us with part of their paycheck and we try to be good stewards of their donation. To show appreciation for their hard earned donation, we require the letter sent to our office before a casket or urn is sent to you.

You must not be receiving funds from another organization to help with the casket or urn for the baby.

We will only send caskets or urns ground shipping or priority mail. We do not send out caskets or urns express mail.

The baby urns can be used for any pregnancy or infant loss. The caskets only go up to 24 inches (because we are keeping our primary missional focus on pregnancy loss – where the baby dies in the womb).

If you have any questions please email staff@heavensgain.org

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Your Contact Information

First Name *

Last Name *

Phone 1 *

Email *

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

YOUR APPLICATION

Please explain your financial hardship:

Upload your proof of financial need (i.e. government assistance card)

Which item are you requesting for free? *

If ordering an urn, what skin tone is preferred?

(Optional) If we are able to include a label/plate with the baby's name, what would you want it to say (limit 30 characters - not 30 words)?

I will mail Heaven's Gain a thank you note addressed to "Heaven's Gain Donors" to 6962 Harrison Ave, Cincinnati, OH 45247. I understand Heaven's Gain needs to receive it before they can mail out my casket/urn.

Yes

Are you receiving burial benefits from any other organization? *

Yes

If yes, which organization?

What is the estimated length of your baby in inches? (For estimates by gestation: https://heavensgain.org/gestation-length-and-size-of-casket/) *

Estimated weeks pregnant when baby died (Enter a Number) *

Are you interested in a peer support appointment or attending a support group?

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