Bereavement Information Sheet
The Park Church
Today's Date
-
Month
-
Day
Year
Date
Name of Caller/Person Making Contact
First Name
Last Name
Phone Number
Please enter a valid phone number.
Relationship to the bereaved
Name of Primary Contact (Park Church Member)
First Name
Last Name
Phone Number of primary contact
-
Area Code
Phone Number
E-mail of Primary Contact
example@example.com
Address of Primary Contact
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Deceased Relationship to Park Member
Name of the deceased
Date of Death
-
Month
-
Day
Year
Date
Age of deceased
Was the deceased a member of The Park?
YES
NO
Other family members at The Park and relationship to the deceased.
Name/Address/Phone Number of each
Any youth (Park members) impacted by the death?
YES
NO
If yes, please advise name and relationship to the deceased, along with address and contact info for youth.
Name of Funeral Home
Address of Funeral Home
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Funeral Home Phone Number
Please enter a valid phone number.
Visitation Date/Time
Address of Visitation
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Homegoing Date/Time
Address of Homegoing
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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