Nurses Honor Guard Service Request

This form is for families, colleagues, and funeral homes to request a ceremonial tribute to honor the life and dedicated service of a departed nurse. Our team provides a respectful and warm final tribute during services or burials. Once submitted, our team will review the request and follow up promptly to confirm details and coordinate the attendance of our Honor Guard members.

Nurses Honor Guard Request For Service

Please provide the details for the ceremonial service to honor a fallen colleague or living nurse.

First Name (who is requesting)

Last Name (who is requesting)

Email Address (who is requesting)

Phone (who is requesting)

Requestor's relationship to the Nurse

In Memory or Honor of (Name of Nurse):

Family Contact (name and relationship)

Family Contact Phone

Service Type

Date (leave blank if date is to be determined)

Month

Day

Year

Service Address (where the funeral or tribute will be held-type TBD if not yet determined)

Funeral Home (Type N/A if does not apply)

Funeral Home Address (Type N/A if does not apply)

Funeral Home Phone (leave blank if it does not apply)

Funeral Director Handling the Service (Type N/A if does not apply)

Lantern Recipient Name (for Funeral Services only-type N/A if it is not a funeral)

Photo 📷

Please upload an image of the nurse.

Additional Details

What Happens After You Submit

Request Review: Our leadership team carefully reviews each submission to understand the specific needs of the honor guard service.

Coordination: We coordinate directly with the family and the designated funeral home to ensure a seamless integration of the tribute.

Volunteer Availability: As a volunteer-led organization, our presence depends on the schedules of our dedicated honor guard members.

Confirmation: A team member will reach out to you via phone or email to confirm all final details and logistics.

Our mission is to provide comfort and honor during this difficult time. We thank you for allowing us to serve.