Funeral Intake

Please indicate date and time for the Mass:

Personal History

Name of the Deceased

Nickname (if any)

Place of Birth

Marital Status

Married

Single

Is the spouse living or deceased?

Living

Deceased

Names of Children

Names of Great-grandchildren

Names of Parents (please indicate if living or decesased)

Age of the Deceased

Date of Birth

Was the deceased a parishioner?

Yes

Deceased's Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Spouse's Name

How many years married? (if applicable)

Names of Grandchildren

Names of Brothers/Sisters

Next of Kin

First Name

Last Name

Relation to the deceased:

Next of Kin Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone/Mobile

Background Information

What was the deceased's occupation?

What are some qualities that made this person special?

Please indicate any special interests, hobbies or talents

Faith Life

How did this person see their relationship with God?

Were they involved in any ministries of the parish?

Who were the primary caregivers?

Please note any special requests you may have for the celebrant:

The Mass of Christian Burial

Casket or Cremated Remains?

Will family members place the pall over the casket?

Yes

N/A

Readings and Lectors

Please choose an Old Testament, New Testament reading, and petition option from the workbook or PDF provided by our parish (see top of page). If the family chooses not to read these selections at the Funeral Mass, members of the Funeral Support Ministry Team will be happy to assist by reading the passages the family has chosen.

Will your family choose the Scripture passages? (If yes, please select readings from options below)

Yes

First Reading (select one):

Second Reading (select one):

Intercession Option

Will a family member or friend serve as a reader during the Mass?

Yes

Name of Reader for First Reading:

Name of Reader for Second Reading:

Name of Reader for Prayer of the Faithful:

Please choose 2 or 3 family members or friends to offer the gifts of bread and wine to the altar. Please indicate their names below:

Will someone deliver Words of Remembrance?

Name of person delivering Words of Remembrance:

Livestream Request

At Saint Helen we are able to livestream funerals. Upon confirmation of request, you will receive a private link to the livestream to share with family and friends. The private link will be saved so if you are unable to view it live it can be watched at your convince.

Would you like the service to be livestreamed?

Yes

Music for the Mass of Christian Burial

This is a list of some commonly requested songs for Roman Catholic funerals. Reasonable requests of music not on this list can be accomodated.

Please feel free to email or call Adrian with questions or additional request. These selections can be listened to on YouTube. If there are no preferences, the musician will choose appropriate hymns.

Director of Liturgy and Music, Adrian Soltys
908-232-1214 ext 121
[email protected]

Entrance (please choose one):

Psalm (please choose one):

Preparation (please choose one):

Communion (please choose one):

Commendation (please choose one):

Recessional (please choose one):

Other Music Requests:

Funerals at Saint Helen

Mass of Christian Burial Intake Form