Shining Lakes Grove, ADF
In order to prepare arrangements for services following your death we request the following information. The Grove will do its best to see that your desires are fulfilled but extenuating circumstances, such as resistance of your relatives, may impede us from completing this work. All information will be kept confidential until after your death. Upon completion of this form you should schedule a meeting with the Senior Druid to discuss your arrangements.
Name: Magical _________________________________________________________________ Legal: _________________________________________________________________ Address: _________________________________________________________________ Name & Addresses of Closest Relatives: Name Address Telephone ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Which relatives listed above are aware of your religious orientation? ________________________________________________________________________________ If none of them are aware do you wish for them to be informed? Yes No If your family plans a memorial service that differs from your request should the Grove make this information known to them? Yes No If a separate Neopagan Memorial is necessary are there any members of your family who should be invited? ________________________________________________________________________________ Location of Burial Plot: _______________________________________________________ Do you desire burial or cremation? (Please circle your preference) Do you desire calling hours? Yes No Do you wish to be an organ donor? Yes No Do you have a will? Yes No If Yes, Name of Attorney and/or location of will: ________________________________________________________________________________ Do you have a preference for memorial gifts? ________________________________________________________________________________ What is your primary Neopagan religious orientation? (Druidism, Wicca, etc.) ________________________________________________________________________________ Are there any other individuals or groups that should be informed of your passing? (please attach listing with contact information on a separate page) Do you have any primary Deities which should be invoked at your memorial? (Please list below.) ________________________________________________________________________________ Do you wish to have any items buried/burned with you (legal restrictions may apply)? ________________________________________________________________________________ Do you have any special instructions for the disposition of your personal religious objects? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ List your three favorite songs or chants for possible inclusion in your memorial service: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Are there any particular poems or readings which you desire for your service? ________________________________________________________________________________ Do you have any other special requests for your memorial service? ________________________________________________________________________________ ________________________________________________________________________________ Do you wish to have your name placed on the Grove Ancestor Memorial? Yes No Do you desire to be called to join the Grove's Samhain celebration each year? Yes No If yes, are there special incenses or foods that you would like to have offered if possible? ________________________________________________________________________________ Your LEGAL signature ________________________________________________________________________________ Notary Seal