Assistance

Apply for Assistance

A Small Way We Can Help

First and foremost, we want you to know that we are deeply sorry for your loss. No words can ease the heartbreak of losing a baby, and we wish with all our hearts that you weren’t walking this path. The FlutterBy IzzyJane Foundation was created by Danny and Molly Young who have been where you are — and it’s our mission to offer support, even in the smallest way, during this time.

If you are seeking help with funeral expenses, we have a few steps to guide you through the process. Please review the following qualifications before submitting your application:

To qualify for assistance:

– Medical release information will need to be provided.

– Your baby was stillborn at 24 gestational weeks or later.

We know these details are difficult to share. Please know that every step of this process is handled with care, compassion, and the deepest respect for you and your baby.

Apply for Assistance

Parent Information

Fathers & Mothers Names*

Mother's Birth Date*

Baby Information

Baby's Names & Delivery Date*

Gestational Weeks of Baby*

Delivery Hospital & Doctor's Name*

Doctor's Office Phone Number*

Contact Information

Email*

Phone*

Street Address*

City*

State / Province / Region*

ZIP / Postal Code*

Country*

Patient’s Medical Release & Authorization

By checking the box below and typing your name, you authorize the FlutterBy IzzyJane Foundation to access and receive your patient information concerning the following:

1. Delivery Information
2. Copy of Birth Certificate “Resulting in Stillborn.”

I authorize the release of my patient information*

Printed Name / Signature*

First Name*

Last Name*

Additional Comments