Legacy Form (Parents) — Earth Dream Media

Your father's name

First Name

Last Name

Your mom's name (fill out with her maiden name)

First Name

Last Name

Their ages

What is your relationship with them?

(son, daughter, friend, etc)

Their Phone #

I'll be giving them a short call to connect and make them feel at ease.

(###)

###

####

Their Email

I will use this email to send a questionnaire so that they feel prepared beforehand. (Enter mailing address if a letter would be more appropriate for your loved one)

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Give us a short overview of their story.

Example: "Dad grew up in a small town in Kansas. He served in the military in the 1980s, mom grew up singing in church. Her dad was the pastor..."

Do you have any stories you'd like them to tell?

If so, tell me how you would ask to hear the story. Example "ask them about the time she nearly wrecked dad's 51 chevy on the first date"

Would you like to include photos in the film?

Ken Burns style photos + $3.00 per extra photo. (depending on which package you choose you will have 10-20 photos included)

Yes

Do you have any special requests?

Example 1: "Mom has such a wonderful laugh, we really want to capture it" Example 2: "Dad had an alcoholic father and accepted Jesus at 13. I just really want to capture his perspective on life in regard to his faith."

Does your loved one have any medical conditions to be considerate of?

What are some of their favorite things?

If they love a particular car, gardening, favorite movies, etc, I will research the topic so I can engage with them in easy conversation to make it a great experience for them.

If you have any questions, type them below and we'll talk about them over the phone!

(Schedule your call below)

Please schedule your phone call below. This is an essential part of helping us provide the best product and experience possible.