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A young boy and girl run through a meadow of butterflies as a large hand descends from above and grasps a small hand.

Join Us at Junto Wine | October 12, 2025 Click here to Learn more

Brick Payment Form

If you've sent a brick order form in the mail but would like to make a payment online, please utilize the payment form below.

Memorial Brick Payment Form

Brick Information

To help us assure this payment is applied to the correct memorial brick order, please provide the following information:

Payment Information

Brick Choice

How am I eligible for a brick?

Any child ranging from unborn to adulthood, who has one living parent when the child passed, may be remembered with one brick on the Children’s Memorial walls.

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  • Multiple names on one brick are allowed.

  • The Memorial bricks are designed for letters, spaces, dashes (-), slashes (/), and numbers only.

  • Each line can accommodate 18 characters and spaces.

  • Two sizes of bricks are available: ​

    • 4" x 8" bricks accommodate 3 lines of text and cost $125​

    • 8" x 8" bricks accommodate 6 lines of text and cost $250​

  • The form and full payment must be received by March 1st. All brick payments and forms received after this date will be etched the following year.          

  • A Memorial brick consent proof will be sent to the parent(s) for approval prior to etching.

  • If being purchased by a donor:

    • Parents will receive an introductory letter about the brick size and etching suggested. The parent will approve or edit the message to be etched on the brick.

memorial bricks on a brick wall with white grout and a white ledge

If you haven't submitted your brick order yet, please:

Click here to print a physical order form

Memorial Brick Order Forms along with payment can be sent to:

Heartfelt Inc.
PO Box 201
Seward, NE 68434

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