Language
English (US)
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FUNERAL INTAKE FORM
DECEASED INFORMATION
Deceased Name
*
First Name
Last Name
Date of Death
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
Date of Birth
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Comments
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FAMILY CONTACT INFORMATION
Family Contact Name
*
First Name
Last Name
Relationship to Deceased:
*
Member of Holy Redeemer?
*
Yes
No
Phone Number
*
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Language of Service
*
English
Spanish
Bilingual
Comments
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FUNERAL SERVICE INFORMATION
Funeral Home Name
Representative Name
Phone Number of Representative
Format: (000) 000-0000.
Services requested
*
Wake Service
Funeral Mass
Rite of Committal
Memorial Mass
Wake Service
Date of Wake Service
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Wake Service
Hour Minutes
AM
PM
AM/PM Option
Presider
Funeral Mass
Date of Funeral Mass
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Funeral Mass
Hour Minutes
AM
PM
AM/PM Option
Presider for Funeral Mass
Location of Funeral Mass
Divine Child Chapel
Main Church
Marian Chapel
Other
Remains
Body
Cremains
Music
Yes
No
Livestream (Only available in the Main Church)
Yes
No
Pall
Yes
No
Presentation of gifts
Yes
No
Rite of Committal
Date of Rite of Committal
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Rite of Committal
Hour Minutes
AM
PM
AM/PM Option
Presider for Rite of Committal
Cemetery Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Memorial Mass (No remains)
Date of Memorial Mass
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Memorial Mass
Hour Minutes
AM
PM
AM/PM Option
Presider for Memorial Mass
Location of Memorial Mass
Divine Child Chapel
Main Church
Marian Chapel
Other
Music
Yes
No
Livestream (Only available in the Main Church)
Yes
No
Presentation of gifts
Yes
No
Comments
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Liturgy & Music
LITURGY
First Reading (Old Testament)
Please Select
Job 19: 1, 23-27
Wisdom 3:1-9
Wisdom 4:7-14
Isaiah 25:6a, 7-9
Lamentations 3:17-26
Daniel 12:1-3
2 Maccabees 12:43-46
Reader for First Reading
Responsorial Psalm
Please Select
Psalm 23
Psalm 25
Psalm 27
Psalm 42
Psalm 63
Psalm 103
Psalm 116
Psalm 122
Psalm 130
Reader for Responsorial Psalm (If no music)
Second Reading (New Testament)
Please Select
Acts of the Apostles 10:34-43
Romans 5:5-11
Romans 5:17-21
Romans 6:3-9
Romans 8:14-23
Romans 8:31b-35, 37-39
Romans 14:7-9, 10c-12
1 Corinthians 15:20-28
1 Corinthians 15:51-57
2 Corinthians 4:14-5:1
2 Corinthians 5:1, 6-10
Philippians 3:20-21
1 Thessalonians 4:13-18
2 Timothy 2:8-13
2 Timothy 4:6-8, 17-18
1 John 3:1-2
1 John 3:14-16
Revelation 14:13
Revelation 20:11-12:1
Revelation 21:1-5a, 6b-7
Reader for Second Reading
Gospel
Please Select
Matthew 5:1-12a
Matthew 11:25-30
Matthew 25:1-13
Matthew 25:31-46
Mark 15:33-39, 16:1-6
Luke 7:11-17
Luke 12:35-40
Luke 23:33, 39-43
Luke 23:44-46, 24:1-6a
Luke 24:13-35
John 5:24-29
John 6:37-40
John 6:51-58
John 11:17-27
John 11:32-45
John 12:23-28
John 14:1-6
John 17:24-26
John 19:17-30, 25-39
Reader for Prayer of the Faithful
Eulogy
Yes
No
Comments
MUSIC
Entrance Song
Responsorial Psalm
Please Select
Psalm 23
Psalm 25
Psalm 27
Psalm 42/43
Psalm 63
Psalm 103
Psalm 116
Psalm 122
Psalm 130
Offertory Song
Communion Song
Recessional Song
Other
Comments
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PERSONAL COMMENTS
Cause of Death
Husband/Wife
Parents
Children
Grandchildren
Siblings
Place of Birth
Where he/she grew up
Profession
Accomplishments
Family details
Family Religion
Personality
Other Details:
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