Surveypoint

Q1

Deceased's full name:

Q2

Date of First Visit

Date

Q3

Date of Birth

Date

Q4

Date of Death

Date

Q5

Location of Death

Q6

Cause of Death

Q7

Name

First Name

Q8

Name

Last Name

Q9

Phone Number

Q10

Email

Q11

Address

Street Address

Q12

Address

Street Address Line 2

Q13

Address

City

Q14

Address

State / Province

Q15

Address

Postal / Zip Code

Q16

Relation to deceased:

Q17

Funeral Directors:

Q18

Funeral being presided over by:

Q19

Location of Funeral:

Q20

Date of Funeral:

Date

Q21

Time of Funeral:

Hour

1

2

3

4

5

6

7

8

9

10

11

12

Q22

Time of Funeral:

Minutes

00

10

20

30

40

50

Q23

Time of Funeral:

AM/PM Option

AM

PM

Q24

Person responsible for Order of Service:

Q25

Type of Service:

Funeral

Cremation

Burial

Thanksgiving

Q26

Are any of the following required?

Organist

Pianist

Other Musicial

Sound Desk Operator

Q27

Choice and order of songs or hymns:

Q28

Choice and order of any recordings:

Q29

Choice of any Bible passages or readings:

Q30

Name of anyone intending to give a eulogy:

Q31

Service Sheet being made by:

Q32

No. of Service Sheets required:

Q33

Funds designated to:

Q34

Black Cloth:

Yes

No

Q35

Flowers provided by:

Family

Church

Other

Q36

Location of burial/cremation:

Q37

Date of burial/cremation:

Date

Q38

Time of burial/cremation:

Hour

1

2

3

4

5

6

7

8

9

10

11

12

Q39

Time of burial/cremation:

Minutes

00

10

20

30

40

50

Q40

Time of burial/cremation:

AM/PM Option

AM

PM

Q41

Location of wake

Q42

Time

Hour

1

2

3

4

5

6

7

8

9

10

11

12

Q43

Time

Minutes

00

10

20

30

40

50

Q44

Time

AM/PM Option

AM

PM

Q45

Open invitation to the Wake?

Yes

No

Q46

Family/deceased a member of a Church?

Q47

Does the Family require food at home?

Yes

No

Q48

Copy Instructions to:

Admin

Finance

Verger

Youth Worker

Children's Worker

Cleaners

Q49

Where was the deceased born?

Q50

When was the deceased born?

Date

Q51

What were their parents' names and occupation(s)?

Q52

Siblings' names and order of birth(s)?

Q53

Schooling and Education?

Q54

Professional or Domestic History?

Q55

What was the deceased like as a child?

Q56

Childhood memories that the deceased or the siblings have recounted?

Q57

Interests, Hobbies, Achievements and Honours?

Q58

Name of Spouse:

Q59

Additional information

Q60

If married, information about courtship etc.

Q61

Wedding date:

Date

Q62

Quick reference - children/grandchildren etc.

Q63

Children? Their names and dates of birth?

Date

Q64

Spiritual biography/Story of conversion?

Q65

Church experiences and early spiritual memories?

Q66

Spiritual experiences and Commitments?

Q67

What was the deceased like:

Q68

As a spouse...

Q69

As a parent...

Q70

As a person...

Q71

As a Christian...

Q72

Follow Up Visit Required?

Date

Q73

Date to send Anniversary Card

Date

Funeral Preparation Form -Form Fill

Deceased's full name:

Date of First Visit

Date of Birth

Date of Death

Location of Death

Cause of Death

Name

Name

Phone Number

Email

Address

Address

Address

Address

Address

Relation to deceased:

Funeral Directors:

Funeral being presided over by:

Location of Funeral:

Date of Funeral:

Time of Funeral:

Time of Funeral:

Time of Funeral:

Person responsible for Order of Service:

Type of Service:

Are any of the following required?

Choice and order of songs or hymns:

Choice and order of any recordings:

Choice of any Bible passages or readings:

Name of anyone intending to give a eulogy:

Service Sheet being made by:

No. of Service Sheets required:

Funds designated to:

Black Cloth:

Flowers provided by:

Location of burial/cremation:

Date of burial/cremation:

Time of burial/cremation:

Time of burial/cremation:

Time of burial/cremation:

Location of wake

Time

Time

Time

Open invitation to the Wake?

Family/deceased a member of a Church?

Does the Family require food at home?

Copy Instructions to:

Where was the deceased born?

When was the deceased born?

What were their parents' names and occupation(s)?

Siblings' names and order of birth(s)?

Schooling and Education?

Professional or Domestic History?

What was the deceased like as a child?

Childhood memories that the deceased or the siblings have recounted?

Interests, Hobbies, Achievements and Honours?

Name of Spouse:

Additional information

If married, information about courtship etc.

Wedding date:

Quick reference - children/grandchildren etc.

Children? Their names and dates of birth?

Spiritual biography/Story of conversion?

Church experiences and early spiritual memories?

Spiritual experiences and Commitments?

What was the deceased like:

As a spouse...

As a parent...

As a person...

As a Christian...

Follow Up Visit Required?

Date to send Anniversary Card