OBITUARIES
ABOUT US
OUR SERVICES
PLAN AHEAD
GRIEF SUPPORT
RESOURCES
CONTACT US

.

OBITUARIES
ABOUT US
OUR SERVICES
PLAN AHEAD
GRIEF SUPPORT
RESOURCES
CONTACT US

PrePlanning Form

Make these important decisions in the privacy of your own home with our simple online pre-planning form.

Online Preplanning Form

Free Text

Personal Information

Who is this plan for?

First Name

Middle Name

Last Name

Free Text

About You

Email Address

Phone Number

Free Text

Family, Work, & Education

Free Text

Family Information

Father's Name

Father's Address

Mother's Name

Mother's Address

Mother's Maiden Name

Marital Status

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Date of Marriage

Free Text

Additional Family Members

Siblings (alive)

Siblings (deceased)

Children (alive)

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

Free Text

Education History

School Name

Highest Level of Education

School Location

Free Text

Work History

Occupation

Company Name

Years At Company

Did this person serve in the military?

Yes

No

Free Text

Your Wishes

Visitation Options

Visitation at funeral home

Visitation elsewhere:

No Visitation

Funeral Service Option

Funeral service at funeral home

Funeral service elsewhere

No Visitation

Reception Options

Reception at funeral home

Reception elsewhere:

No Visitation

Would you prefer burial or cremation?

Burial

Cremation

Final Disposition

Ground Interment (burial)

Mausoleum Entombment (above ground burial)

Columbarium (for cremation urns)

Ashes returned to family

Would you prefer to include a graveside/committal service?

Yes

No

Free Text

Your Preferences

Please list any musical selections you would like to include in your services.

Please list any special themes you would like to include in your services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Please list any specific foods or beverages you would like to make available to your family and guests at the services.

Please list any interests or hobbies you would like to include into your services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

Thank you! Your submission has been received!

Oops, there was an error sending your message.
Please try again later.

3204 Mountain Rd, Pasadena, MD 21122, United States

For Immediate Assistance

Call 410-255-2381

3204 Mountain Rd, Pasadena, MD 21122, United States

© McCully Polyniak & Collins Funeral Home. All Rights Reserved.

Privacy Policy | Terms of Use | Admin Login

Share by: