Funeral Intake Form • St. Hilary Church

Today's Date *

First Name *

Middle Name

Last Name *

Preferred Name

Mailing Address *

Tip: Please enter the deceased person's most recent mailing address prior to his or her death

Mailing City *

Mailing State *

Mailing Zip Code *

Age at death *

Date of Birth *

Date of Death *

Was the deceased baptized Catholic? *

Name of Contact Person *

Email Address *

Phone Number *

Relationship to Deceased *

Is there more than one contact person? *

Name of Contact Person *

Email Address *

Phone Number *

Are arrangements being made through a funeral home? *

Name of Funeral Home *

Funeral Home Contact Name *

Type of Remains *

Services Requested *

Eulogy

Memorial Mass

Music

Reception in Parish Hall

Special Requests

Office Use Only - Date & Time of Funeral

Office Use Only - Celebrant Name & Authorization

Office Use Only - Funeral Date & Time Entered into Parish Calendar?

Office Use Only - Date & Time of Meeting with Celebrant

Office Use Only - Date Musician Contacted

Office Use Only - Date Altar Servers Requested

Office Use Only - Date Funeral Greeters Requested

Office Use Only - Other Volunteers Requested

Office Use Only - Will there be a worship aid? Who will prepare?

Office Use Only - Where will reception be held?

There will be no reception

Reception will be held in Parish Hall

Reception will be held offsite - all are invited

Reception will be held offsite - only family & friends

Office Use Only - Date Hall Manager Contacted & Event Form Completed

Office Use Only - Date Pictures Requested

Office Use Only - Date School Notified to Open Gates

Office Use Only - Donation for Church Received?

Office Use Only - Donation for Priest Received?

Office Use Only - Donation for Altar Server(s) Received?

Office Use Only - Fee for Parish Hall Received?

Office Use Only - Priest Notes

Office Use Only - First Reading

Office Use Only - Second Reading

Office Use Only - Gospel Reading

Office Use Only - Date Deceased Archived in Database

Office Use Only - Date Recorded in Funeral Book

St. Hilary Church Funeral Information Form

Information on Deceased Person

Information on Contact Person(s)

Information on Funeral Home

Information on Funeral Service

Office Use Only