Funeral Service Request Form

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 NameMiddle NameLast Name
2. Address of Deceased*

Street Address

Street Address Line 2

CityState

Zip Code
3. Date of Birth*

MonthDayYear
Date
4. Date of Death*

MonthDayYear
Date
5a. Is the deceased a parishioner at St. Hedwig Church?*

YesNo
5b. If not a St. Hedwig Church parishioner, what is their parish?
Parish, City & State

Family Representative

Relative making funeral decisions
6. Family Representative (Name & Relationship)*

First NameLast Name
Relationship to the Deceased*
Date of Anointing of the Sick & the priest's name:*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
2. Family Representative Address*

Street Address

Street Address Line 2

CityState

Zip Code
7a. Is the family representative a parishioner at St. Hedwig Church?*

YesNo
7b. If not a St. Hedwig Church parishioner, what is their parish?
Parish, City & State

17. Potential Funeral Dates

Please pick two possible funeral dates and times below.
Funeral Date Option 1*
Option 1 Time*

Hour Minutes

AM/PM Option
Funeral Date Option 2*
Option 2 Time*

Hour Minutes

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:*

BulletinWebsiteNovember 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:
Should be Empty:

St. Hedwig Funeral Service Request Form