Pre-Planning Checklist and Preferences for Your Funeral
or Memorial Service
Pre-planning your funeral or memorial service can provide peace of mind for you and lower anxiety for your
family and friends during an emotionally charged period. You can design and specify the exact type and
content of service that you would prefer. This will let your family and friends celebrate you and your life as you
would wish. Your family will not have to be conflicted or anxious about the complicated and emotional
decisions that will have to be made. This is meant to be of assistance in allowing you to make some of the
more relevant decisions to allow for the celebration of your life.
Name: Date of Birth:
Address: ___ Phone:
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What type of Service and Events do You Wish to Have
Decide on the type of Service
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I would like to have a funeral service, followed by burial, interment or cremation. Funeral service to be held
______in the Church,
______at the grave site/interment facility or
______at the mortuary chapel.
Register Book Yes No
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______I would like to have a memorial service at the church after the family only burial/interment or cremation
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_______I would like to have a funeral service in my own home or facility
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_______I would prefer to a morning or afternoon service
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_______I would prefer a meal be prepared at the Church for family or family / friends
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_______I would ask that my family be seated on the right side left side of the Sanctuary as looking into the Sanctuary.
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Other;
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Decide if you wish any other funeral particulars;
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______I would like to have a viewing before the funeral
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______I would like to have a wake before the funeral/service
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______I would like to have a visitation before the funeral/service
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______I would like to have a reception or gathering in Fellowship Hall or elsewhere after my funeral or memorial service; location
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Instead of flowers, I wish Contributions to be made to
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The casket or urn would be present during the service: yes___ no ____
The casket to be open prior to the service_____ yes _______ no; the casket will be closed after the service.
2. I would prefer my funeral be facilitated using the services of funeral home:
, located in ,
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Identify Personal Touches You’d Prefer at the Service
For the funeral or memorial service;
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The person I would like to officiate my funeral or memorial service is___________________
If unable for any reason, my second choice is
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_______I would like the following, if able and available, to serve as pallbearers:
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Phone
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Phone
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Phone
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Phone
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Phone
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Phone
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_______I would like the following, if able, willing and available, to deliver a Time of Tribute:
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Phone _
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Phone _
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Phone _
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______I would like the following, if able, willing and available, to tell true stories of my life:
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Phone _
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Phone _
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Phone _
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For the content of the funeral or memorial service:
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________I would like the following music/hymn selections
1.
2.
3.
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________I would appreciate music presented by
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Instrumental
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Solo/Ensemble
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Choir
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Organist
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None
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_______ I would like the following scripture texts presented;
1.
2.
3.
4.
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The Cemetery is , located miles from the Church.
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Military or Fraternal Order service at the grave/interment site: yes no
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Flag Presentation or Honor Guard at grave/interment site: yes no
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I would want to be sure that the following groups, organizations, service clubs will be notified
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of and invited to any service on my behalf.
a. Phone
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Phone
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Phone
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Phone
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I would want the following people, whom my family may know, to be notified of and invited to any
service on my behalf:
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Phone
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Phone
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Phone
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Phone
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I understand that in the State of Texas, an Advanced Directive Form (to communicate your wishes
about medical treatment at some time in the future when you might be unable to make your wishes
known) is required by law, along with the Medical Power of Attorney and, if so desired, the
Out of Hospital Do Not Resuscitate Order. These are the responsibility of the family of the
individual for whom this service is intended. The need for these documents is acknowledged
by my signature below:
Name of Person Requesting a Service
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Prepared by: Name Date
Witnessed by: Name Date
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Acknowledged by First Presbyterian Church of Mabank on
____________________________________
Date Signature
itle:
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Number
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First Presbyterian Church Mabank
Funeral Planning Form
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FPCM
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-12
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-1
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Printed Name
(05/19/2019 approved by Session)
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