St. Hedwig Funeral Service Request Form
Note: This Funeral Service Request Form must be completed and is only provisionary. All arrangements will be confirmed by the Bereavement Ministry.
Deceased Information
1. Name Of Deceased
*
First Name
Middle Name
Last Name
2. Address of Deceased
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
3. Date of Birth
*
-
Month
-
Day
Year
Date
4. Date of Death
*
-
Month
-
Day
Year
Date
5a. Is the deceased a parishioner at St. Hedwig Church?
*
Yes
No
5b. If not a St. Hedwig Church parishioner, what is their parish?
Parish, City & State
Back
Next
Save
Family Representative
Relative making funeral decisions
6. Family Representative (Name & Relationship)
*
First Name
Last Name
Relationship to the Deceased
*
Date of Anointing of the Sick & the priest's name:
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
2. Family Representative Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
7a. Is the family representative a parishioner at St. Hedwig Church?
*
Yes
No
7b. If not a St. Hedwig Church parishioner, what is their parish?
Parish, City & State
Back
Next
Save
Person completing this form
(If different from deceased representative above)
8. Person completing this form
*
First Name
Last Name
Is the point of contact the same person as the one completing the form?
*
Yes
No
Relationship to the Deceased
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Back
Next
Save
10. Point of Contact
Who is the point of contact?
First and Last Name
Relationship to the Deceased?
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Back
Next
Save
Funeral Planning Questionaire
11. Type of Funeral Requesting (if known)
*
Funeral Mass with Cremains
Funeral Service with Casket
Graveside Only
I Do Not Know
12. Approximate # Attending
*
13. Immediate Burial following the funeral service?
*
Yes
No
I Do Not Know
14. Share anything you think we should know about the funeral (musician request, etc.)
*
Mortuary & Cemetery Information
15. Name of Mortuary
*
Mortuary Contact
*
First Name
Last Name
Mortuary Phone Number
*
Please enter a valid phone number.
Mortuary Email
example@example.com
16. Name of Cemetery
*
Cemetery Address
Cemetery Contact (if known)
First Name
Last Name
Cemetery Phone Number (if known)
Please enter a valid phone number.
Back
Next
Save
17. Potential Funeral Dates
Please pick two possible funeral dates and times below.
Funeral Date Option 1
*
Option 1 Time
*
Hour Minutes
AM
PM
AM/PM Option
Funeral Date Option 2
*
Option 2 Time
*
Hour Minutes
AM
PM
AM/PM Option
18. Please choose the best statement that describes your funeral request.
*
The deceased is a St. Hedwig Parishioner and we want to have the funeral at St. Hedwig Church.
The deceased is not a St. Hedwig parishioner, but a family member is and would like the funeral at St. Hedwig.
The family is considering different parishes to see which one will be the best option.
We want to have the funeral on a specific date or week and if it can not happen at St. Hedwig then we will have to look elsewhere.
Other
19. Do you want your loved one's name included in:
*
Bulletin
Website
November Memorial Mass
Thank you for completing this funeral request form. You must review your answers prior to submission. We will review the information including your requested dates and get back to you within 24 hours (48 hours during holiday weekends). If you have any questions, please email info@sainthedwig.org with the following in the subject line: Last name, First Name Funeral request and date you submitted this form.
Parish Office Only (Parish Office staff completes this section)
Parish Calendar Availability
Camino Parishioner Info.
Env#, # years parishioner
Priest assigned:
Scheduled By:
Print
Save
Submit
Should be Empty: