Online Tribute Starter

Your Name*

Your Phone Number*

Your email address*

Full Name*

What is your loved one's date of birth?*

What is your loved one's date of passing?*

What is your loved one's age?*

Is your loved one male or female?*

Male Female

In what city and state (or country) was your loved one born?*

What is the city and state of residence of your loved one?*

If your loved one attended high school, where did they attend?

If your loved one attended college, where did they attend?

What is the name of your loved one's spouse or partner?

What is the wedding date of your loved one's spouse or partner?

What did your loved one do for work?*

What company/companies did your loved one work for?*

What organizations/civic groups/etc did your loved one participate in?*

What family members have passed away before your loved one? (list name and relationship)*

What family members is your loved one survived by? (list name and relationship)*

Will you be able to provide a recent photograph at the time of your appointment that we can include with this online tribute?*

Yes No

If you would like, you can upload a photo of your loved one here. Choose file

Allowed files: .jpg, .jpeg, .png, .pdf

Chapel of the Chimes Hayward values your privacy. We will never give, sell, rent or otherwise share your email or personal information with any other organization. Privacy Policy.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.