Paperbark Pre Arrangement Form

Pre Arrangement Form

Spirit Babies
It may be helpful to make a cup of tea & slowly go through these questions, there is no rush in this moment especially if death has just occurred. If for any reason you feel overwhelmed by this form please call us & we can go through it question by question with you.

The details are needed for issuing legal documentation & liaising with varying departments. It also helps us to get an idea of what your needs & requests are at this time if we have not yet been in contact.

If you are uncertain about some answers & have no way of finding out, ‘unknown’ is sufficient. To ensure that we have all the details for necessary paperwork, please double check all spelling of names, addresses & information is correct.

Ensure you have pressed submit at the end of the form we will be in contact to confirm that we have received it.

Please call 0406 103 699 if you are needing guidance here.
Authorisation Statement

Please fill in your details below and sign the authorisation request which allows us to bring your little one into our care.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Relationship
Date of birth

DayMonthYear
Driver's License Number
By signing this document, you authorise Paperbark Deathcare to: Collect your little one. Bring them into our care. Arrange for their cremation or burial. Collect their ashes (for cremation only).
Date signed

DayMonthYear
The following questions will help us gather the personal information for your little one. If you're unsure about any question, please write N/A, and we can gather that information later together.
Family name
First given name
Middle/Other given names
Sex
Date of birth
Date of passing

DayMonthYear
Number of weeks gestation
Place of passing
Aboriginal & Torres Strait Islander origin
Parent 1

First NameLast Name
Parent 1 Maiden Name
Parent 1 sex
Parent 1 life status
Parent 1 occupation
Parent 2

First NameLast Name
Parent 2 sex
Parent 2 life status
Parent 2 occupation
Usual doctor, address & phone number or last visited doctor/medical centre
What service would you like? You may select more than one.
Are there any additional requests or instructions for deathcare & funeral arrangements?
Any other additional information you would like us to know?
How did you know about Paperbark Deathcare? Example friend or family, instagram, Google search
By signing this form, you are entering into a service agreement with Paperbark Deathcare to carry out the burial or cremation and any associated ceremony as discussed. This agreement gives us permission to make necessary arrangements on your behalf, including coordinating with external service providers. Please note that invoices are due upon receipt, as we are required to pay our suppliers — such as cemeteries, crematoria, florists, and other vendors — at the time of service. In some cases, a 50% deposit may be required before certain arrangements can proceed. We appreciate your understanding and timely attention to these matters.
Next steps
Should be Empty:

Pre Arrangement Form

Authorisation Statement