Funeral Request Form

As a church body, it is our duty, among many things, to rejoice with those who rejoice and mourn with those who mourn (Romans 12:15). Whether saved or unsaved, the loss of a loved one is a difficult time for family members, and it is our desire to do what we can to make the burden lighter. The purpose of this policy is to be clear about how our church will serve families who are bereaved.
Name of the Deceased*

First NameLast Name
Other Information
Date of Death**

MonthDayYear
Age at Death**
Active Member*

YesNo
Service Information
Date of Visitation/Wake**

MonthDayYear
Wake Time*
Please limit wake services to 3 hours maximum. The funeral home will need to arrange the time to deliver the body with the church office.
Date of Funeral*

MonthDayYear
Time of Funeral*
The Name of the Officiant *
Services Needed
Church Building (Includes us of Taylor Hall)
$250.00 each • 1 - 1
Musician
$100.00 each • up to 1
Sound System*
$50.00 each • 1 - 1
Kitchen Supervisor*
$50.00 each • 1 - 1
Janitor *
$100.00 each • 1 - 1
Contact Information
Name of Applicant*

First NameLast Name
Active Member?*

YesNo
Relationship to the Deceased *

GrandparentParent/GuardianSiblingFamily Friend
Phone Number*
Please enter a valid phone number.
Funeral Home Information
Name of the Funeral Home*
Contact at Funeral Home*
Location of Interment*
Have you read a copy of our funeral policy and procedures?*

YesNo
Should be Empty:

Other Information