Funeral / Burial Information Form
This form is to be filled out by the person organizing a funeral at Christ Church in the immediate aftermath of a death.
Your Information
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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Information about the Deceased Person
Name of the Deceased
*
Birth date of the Deseased
*
Death date of the Deceased
*
Age of the Deceased at time of death
*
Last Address of the Deceased
*
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AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
When will the Deceased be buried of interred?
Where will the deceased be buried or interred?
Upload (8MB)
Does the deceased have a Niche at Christ Church?
*
Please select one option.
Yes
No
Not Sure
No, But I want to purchase a Niche
If the Deceased has a Niche, what is the number?
Does the deceased have written funeral/burial plans, if so, where are they? (Attach them if possible)
*
Please select one option.
Yes
No
Not Sure
Attach Funeral Plans Here If Available
Upload (8MB)
Attach Photo of the Deceased (If available)
Upload (8MB)
Attach Obituary (if available)
Upload (8MB)
Requests for Funeral / Burial
Will the service take place at Christ Church?
*
Please select one option.
Yes
No
If the service is not at Christ Church, where will it take place?
What date would you like the service to happen?
What time of day would you like the service to happen
What type of service would you like to have (select all that apply)
*
Please select all that apply.
Funeral in the Church
Holy Communion
Music at the service
Rite 1 (Traditional
Rite 2 (Contemporary
There will be a Coffin
There will be an Urn with Ashes
I want to use the Parish Hall for a Reception after the service
I plan on having a Wake
What Old Testament Passages do you want?
*
Please select one option.
Isaiah 25:6-9 (He will swallow up death for ever)
Isaiah 61:1-3 (To comfort those who mourn)
Lamentations 3:22-26,31-33 (The Lord is good to those who wait for him)
Wisdom 3:1-5,9 (The souls of the righteous are in the hands of God)
Job 19:21-27a (I know that my Redeemer lives)
What Psalm do you want?
*
Please select one option.
23
27
42:1-7
46
90:1-12
106:1-5
116
121
130
139:1-11
What Epistle do you want?
*
Please select one option.
Romans 8:14-19,34-35,37-39 (The glory that shall be revealed)
1 Corinthians 15:20-26,35-38,42-44,53-58 (The imperishable body)
2 Corinthians 4:16--5:9 (Things that are unseen are eternal)
1 John 3:1-2 (We shall be like him)
Revelation 7:9-17 (God will wipe away every tear)
Revelation 21:2-7 (Behold, I make all things new)
What Gospel passage do you want?
*
Please select one option.
John 5:24-27 (He who believes has everlasting life)
John 6:37-40 (All that the Father gives me will come to you)
John 10:11-16 (I am the good shepherd)
John 11:21-27 (I am the resurrection and the life)
John 14:1-6 (In my Father's house are many rooms)
Will there be a eulogy?
*
Please select one option.
Yes
Nop
What music do you want? (select all that apply)
*
Please select all that apply.
Organ or Piano Music
Soloist
Quartet
Hymns
Other Music - Special Request
I do not want music
If you have any special music request, please let us know
If you want any hymns, please pick three or four
Please select one option.
208 The strife is o’er, the battle done, Victory
287 For all the saints, Sine Nomine
335 I am the bread of life, I am the bread of life
357 Jesus, son of Mary, Adoro te devote
358 Christ the victorious, Russia
482 Lord of all hopefulness, Lord of all joy, Slane
517 How lovely is thy dwelling place, Brother James’ Air
541 Come labor on, Ora labora
620 Jerusalem my happy home, Land of Rest
608 Eternal Father, strong to save, Melita (the Navy Hymn)
645 The King of love my shepherd is, St. Columba
662 Abide with me, Eventide
665 All my hope on God is founded, Michael
671 Amazing grace, how sweet the sound, New Britain
680 O God, our help in ages past, St. Anne
685 Rock of Ages, Toplady
690 Guide me, O thou great Jehovah, Cwn Rhondda
L-54 Nearer, my God, to thee, Bethany
L-60 How great Thou art, How great
L-106 Precious Lord, take my hand, Take my hand, precious Lord
L-188 It is well with my soul, Ville du Havre
If you want a hymn that was not listed above, please write it in here:
Do you want to have a reception in our Parish Hall?
*
Please select one option.
Yes
No
Not sure
Please let us know if you have any special requests?
Submit
Description
This form is to be filled out by the person organizing a funeral at Christ Church in the immediate aftermath of a death.
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