Family Bereavement Notification Form

Family Bereavement Notification Form

We are deeply sorry for your loss. Please complete this form to notify the church administrator of a death in your family. Our team is here to support you during this difficult time. If you have any immediate needs, do not hesitate to contact the church office directly.
Contact Information:
Your Name*

First NameLast Name
Your Phone Number*
Please enter a valid phone number.
Your Email*
example@example.com
Deceased Family Member’s Information:
Full Name of Deceased:*

First NameLast Name
Relationship to You (e.g., Mother, Father, Sibling, etc.):*
Date of Passing:*

MonthDayYear
Date
Was this individual a member of Global Impact Christian Ministries?*

YesNo
Funeral / Memorial Service Information:
Will there be a funeral or memorial service?

YesNo
If yes, please provide the following details (if available):
Date of Service:

MonthDayYear
Date
Time of Service:

Hour Minutes

AM/PM Option
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Support:
Would you like pastoral care or support?

YesNo
Would you like the church to assist with any service arrangements?

YesNo
Is there anything else you would like the church to know or any special requests?
Preferred Method of Contact for Follow-Up:

Phone CallEmailIn-Person VisitOther
Thank you for informing us. A church representative will reach out to you shortly.
Disclaimer : By providing my phone number to “Global Impact Christian Ministries”, I agree and acknowledge that “Global Impact Christian Ministries” may send text messages to my wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to Opt-out by replying “STOP”.

Privacy Policy : No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
Should be Empty:

Family Bereavement Notification Form

Contact Information:

Deceased Family Member’s Information:

Funeral / Memorial Service Information:

If yes, please provide the following details (if available):

Additional Support:

Thank you for informing us. A church representative will reach out to you shortly.