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Complete this online form to create a Memory Book page for a loved one who has passed away. Rotherham Hospice will review it before the page is created.
This information is about your loved one and will show on the memory page
Please include this exactly as you want displayed (e.g. "née Smith" or "Johnny Jones"):
Please choose the dates below using the date selector. Make sure you use this, or we will not be able to process your submission. Once you have chose the month and year, click on the date to finish.
Upload a photo of your loved one. Minimum size 800x800 and maximum size 3000x3000. If you don't have an image, you can send us one later but for now we'll assign one of our own images to the memory. Please don't add an image you've found on a search, because we are not allowed to display these due to copyright.
You have the option to allow others to comment on the memory page, but rest assured that we review every comment before we allow to them to display
This information will not show on the memory page
Please duplicate the following text below for security