Grace Presbyterian Church
2955 W. Hwy. 160

Ft. Mill, South Carolina 29708

FUNERAL PLANNING WORKSHEET

Please supply as much information as you wish to share.

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Basic Instructions for this document:

This is a Microsoft word document. An effective way to use it would be to create a backup copy of the document using the “Save As” command under “FILE”. Name the document something other than the original name. That will give you a working copy. If you make a mistake, you can always open the original copy of the document. I would suggest that you create a file to store your document in (ex: Grace Funeral Planning). When you have completed the document, or want help doing so, contact Reverend Joanne Sizoo. Her email address is, Joanne@gracefortmill.org . Print a copy of the plans to take with you to the meeting, or just email them to her to keep on file.

Instructions for Entering Phone numbers - (Enter number then tab key)

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Personal Data

Initial Completion Date - Click or tap to enter a date. Revision Date - Click or tap to enter a date.

Please enter your full name in this format (Last, First, Middle): Click or tap here to enter text.

Date of Birth: Click or tap to enter a date. Birthplace: Click or tap here to enter text.

Current Street Address: Click or tap here to enter text.

PO Box (as needed): Click or tap here to enter text.

City: Click or tap here to enter text. State: Choose an item. Zip Code: Click or tap here to enter text.

Phone: Home #: Mobile #:

Email Address - Click or tap here to enter text.

Next of Kin

(Person Most Likely to Contact the Church and Funeral Director)

Name: Click or tap here to enter text. Relationship: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Relationship: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Relationship: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Relationship: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Relationship: Click or tap here to enter text. Phone #:

Name of Attorney (If Applicable)

Name: Click or tap here to enter text. Relationship: Click or tap here to enter text. Phone #:

Funeral Home

Preferred Company: Click or tap here to enter text.

Contact Person: Click or tap here to enter text. Phone #:

Have pre-arrangements been made and purchased? Yes	No

Requested Attire for Burial or Cremation: Click or tap here to enter text.

Jewelry and/or Glasses: Remove for Family Bury with the body

Special Instructions pertaining to Jewelry or glasses: Click or tap here to enter text.

Cemetery

Name of cemetery: Click or tap here to enter text.

Location: Click or tap here to enter text.

Please select the items below that apply:

I have purchased a burial plot:	I have not purchased a burial plot:
I have purchased a headstone / grave marker: Yes No
If YES: Company Name: Click or tap here to enter text.
Contact Person: Click or tap here to enter text. Phone #:
I would like to have the following symbols and/or text printed on the headstone: Click or tap here to enter text.

Care of the Body

Donate Organs: Yes No
If “Yes” to organ donation: Transplant “ONLY” Transplant or medical research
Donate Body to medical science with ashes being returned: Yes No
Embalm and bury body: Yes No
Bury without embalming: Yes No
I wish to have a green burial (Buried without embalming in a biodegradable box/bag) Yes No
Cremate body: After visitation and or service. Before visitation and or service.
Other: Click or tap here to enter text. (Might include Burial at sea, ashes to be spread at a specific location, ashes to be buried.)
Inurnment in a Columbarium: Yes No

Visitation

Do you wish to have a family visitation? Yes No

If yes, preferred location of the visitation: Funeral Home Church Home

Requested time of visitation: Evening before funeral Day of funeral

Open or Closed casket: Yes No

Funeral

Location of Funeral: Grace Presbyterian Church Other

If other, please provide name of church and location: Click or tap here to enter text.

Funeral Home Cemetery Funeral Home Cemetery (Graveside Service Only)

Other: Click or tap here to enter text. Entitled to military honors: Yes No

Branch: Army Navy Air Force Marines Coast Guard

Other Recognition: Masonic Fraternal Civic Honors

Contact Person: Click or tap here to enter text. Phone #:

Flowers or designation for alternate donations

Flowers from family: Yes No What kind? Click or tap here to enter text.

Preference for donations from friends: Flowers: Yes No

Or in lieu of flowers, donations to what preferred organizations? (Grace Presbyterian, etc.)

Click or tap here to enter text.

Type of Worship Service

Please select one (1) type of worship service that you would like:

Funeral Service with Casket or Urn

Memorial service without the remains present

Graveside / Columbarium service only

For funeral or memorial service: Communion celebrated? Yes No

Indicate your favorite:

Biblical theme or image: Click or tap here to enter text.

Scripture reading(s): Click or tap here to enter text.

Hymn(s): Click or tap here to enter text.

Special Music: What? And By Whom? Click or tap here to enter text.

I would like the following family members or friends to be invited to share reflections or readings as part of the service. Please include contact information.

Name: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Phone #:

Please help those that will reflect on your life by sharing information about your life that might be useful in writing a eulogy or words of remembrance (items such as proudest moments, values, important relationships, pivotal life moments, etc.).

Click or tap here to enter text.

Please list anyone who you might want to participate by reading:

Name: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Phone #:

Name: Click or tap here to enter text. Phone #:

Do you wish to have a reception at the church following the funeral? Yes No

End of Life Generosity

I would like someone from Grace Presbyterian Church to contact me to learn more about final gifts, memorial donations, endowments, or estate planning that would help further the mission of the church.

Yes No

Miscellaneous

Please list any other preferences or desires not covered above or situations which may impact on your final arrangements (unique family situations, etc.)

Click or tap here to enter text.

Draft of My Obituary and/or Key Details

Place of birth & date	Schools and year(s) of graduation
Employment and/or volunteer work	Marriage(s); if widowed, date of death of spouse(s)
Younger generations	Community interests and/or hobbies
Proudest individual or family moments	Proudest civic accomplishments/involvement
Special achievements, awards, offices held	Special memories