Survey - Lorraines Garden Pre-Planning Form

Lorraines Garden Pre-Planning Form

Personal Information:

Name:

First Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Phone Number: Required

Remember me.

Companion Animal 1 Information:

Question - Required - Animal 1 Name:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Birth Year:

Question - Required - Species/Breed:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Required - Gender:

Male

Female

Companion Animal 2 Information:

Question - Not Required - Animal 2 Name:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Birth Year:

Question - Not Required - Species/Breed:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Gender:

Male

Female

Lorraine’s Garden Niche

Each niche can hold up to two urns. You may choose to purchase a niche for one or two animals.

Question - Required - Choice:

One niche for a single animal ($600)

One niche for two animals($750)

Cameo

Full niches can accommodate one or two cameos. A high quality digital photo is
required for printing on the cameo. Please e-mail the photo to ccarini@wihumane.org.

$150 per photo (Size: 2¼” x 2¾”)

Question - Required - Choice:

Do not include a photo.

One photo ($150).

Two photos ($300).

Cremation Services

The Wisconsin Humane Society offers private cremation services for those who would like to receive their animal’s ashes. Within 2-4 days of the cremation, our staff will notify you that your urn is available.

Question - Required - I would like my companion to be privately cremated at WHS:

Question - Not Required - If "Yes" to above, which type of urn would you like:

Brushed bronze colored paw print urn ($150).

Premium oak urn ($100).

I will provide an urn at the time of cremation.

Question - Not Required - If "Yes" to above, how would you like to pick up the urn:

I would like to pick up the urn for internment at a later date.

I would like the Wisconsin Humane Society to retain the urn until internment.

Engraving Instructions

Each niche in Lorraine’s Garden is covered with a stunning granite tile. This tile will be engraved in beautiful Vermarco script with your companion animal’s name, birth year, year of death, a personalized memorial inscription and your name. A dignified cameo photograph of your animal may be added for a personalized touch.

Engraving format for full size niche with cameo (one animal)

Question - Not Required - Animal name (Limit 13 characters, spaces count as a character):

Question - Not Required - Birth Year (four digit year):

Question - Not Required - Year of Death (four digit year):

Question - Not Required - Inscription (31 character limit, spaces count as a character. Inscription will appear all on one line):

Question - Not Required - Your Name (31 character limit, spaces count as a character. Name will appear all on one line):

Engraving format for full niche if there are two animals

Question - Not Required - Animal Name (13 characters, spaces count as a character):

Question - Not Required - Birth Year (four digit year):

Question - Not Required - Year of Death (four digit year):

Question - Not Required - Inscription or Name (31 character limit, spaces count as a character. Inscription or name will appear all on one line.):