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Baby Garden Memorial MushroomMemorial No: ___________

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Guidelines for Inscription Please note that only one letter per space and one space between each word. Lines of inscription may use up to 12 letters and spaces. The inscription is all the same size; due to the tablet being circular fewer characters will fit on lines 1, 2, 4 & 5. We suggest using lines 3 & 4 for the name. Please do not write in the shaded areas.

I confirm I have read, understood and agree to the conditions of lease given to me:

Ref: Share/Memorials/February 2015 – Memorial Mushroom at Sandwell ValleyDate: 02/15Responsible Officer: Registration ManagerSandwell Valley Crematorium, Newton Road, West Bromwich, B71 3SX

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Ref: Share/Memorials/February 2015 – Memorial Mushroom at Sandwell ValleyDate: 02/15Responsible Officer: Registration ManagerSandwell Valley Crematorium, Newton Road, West Bromwich, B71 3SX

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Baby Garden Memorial Mushroom

The Mushroom Memorial is a small granite disc, which is placed upon a granite Mushroom within the Baby Garden at Sandwell Valley Crematorium. The Mushrooms are set within tranquil surroundings. A peaceful oak

tree has seating around it, for families to sit and feel comforted in this dedicated area. A wooden gazebo affords provision for floral tributes and tokens to be left in memory of loved ones.

Please be aware from the time of ordering it may take up to eight weeks for delivery.

Please note that payments must be made in full in order for the memorial to be ordered. Payments can be made by Cash, Switch/MasterCard/Visa or Cheque made payable to Sandwell MBC.

Ref: Share/Memorials/February 2015 – Memorial Mushroom at Sandwell ValleyDate: 02/15Responsible Officer: Registration ManagerSandwell Valley Crematorium, Newton Road, West Bromwich, B71 3SX

For Office use onlyCremation NumberReceipt / Auth NumberMemorial NumberDate OrderedDate ErectedSBS Order number

General Data Protection Regulations (GDPR): The personal data provided to Sandwell Metropolitan Borough Council Bereavement Services in this form, is collected and will be managed in accordance with Data Protection Legislation, and is collected solely for the purposes of processing the request for bereavement services, in respect of the deceased person named. The personal data will not be shared with any other parties or organisations, and will be stored for the lease of the memorial period plus a further 2 years, post non-renewal to support future requests regarding this memorial. A full copy of the privacy notice can be found at www.sandwell.gov.uk/bereavement