Clergy Funeral Pre-Planning
Sign in to Google to save your progress. Learn more
Personal Information:
First Name *
Middle Name(s) *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Place of Birth *
Baptism Date *
MM
/
DD
/
YYYY
Confirmation Date *
MM
/
DD
/
YYYY
Ordination Date: Diaconate *
MM
/
DD
/
YYYY
Ordination Date: Priesthood
MM
/
DD
/
YYYY
Names and dates of Congregations served: *
Marriage Date (if applicable)
MM
/
DD
/
YYYY
Spouse/Partner Name (if applicable)
Sibling Names (if applicable)
Children and Grandchildren Names (if applicable)
Schools/Colleges/Universities /Seminaries Attended *
Special Achievements or Awards
Notifications:
Names, addresses, and telephone numbers of persons to notify upon my death *
Funeral/Memorial Information:
I have made pre-arrangements with a funeral home: *
I prefer the following Funeral Home or Cremation Society: *
My Burial Instructions:
The Episcopal Tradition is that members are normally buried from the church. The Book of Common Prayer indicates the body/ashes are to be present, although a memorial service may be held.
Type of Celebration (please click all that apply) *
Required
If you selected Military Celebration, what branch?
Coffin/Urn Specifications: *
I request that donations be made in my name to: *
Scripture Readings:
First Reading *
If you selected other, please list preferred First Reading:
Second Reading *
If you selected other, please list preferred Second Reading:
Psalm *
If you selected other, please list preferred Psalm:
Musical Selections:
I prefer to have music at my celebration: *
If yes, please list any hymns and/or special music requests below:
Preferred Preacher Name and Contact Information *
Special Notes/Requests
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Episcopal Diocese of Missouri. Report Abuse