Funeral Request Form

Requester Information *

First Name

Last Name

Phone *

(###)

###

####

Event Coordinator *

First Name

Last Name

Phone *

(###)

###

####

Deceased Name *

First Name

Last Name

Event Start Date *

MM

DD

YYYY

Event End Date *

MM

DD

YYYY

Event Start Time *

Hour

Minute

Second

AM PM

Event End Time *

Hour

Minute

Second

AM PM

Preparation Start Date *

MM

DD

YYYY

Preparation End Date *

MM

DD

YYYY

Preparation Start Time *

Hour

Minute

Second

AM PM

Preparation End Time *

Hour

Minute

Second

AM PM

Volunteer Staff Request *

Staff availability is not guaranteed and will be based on the timing of this Request.

Media Team

Music Team

Hostess Staff

Usher Staff

Housekeeping

N/A

Approval or License Needed *

Pastor

License

By selecting the box below, you are stating that you understand and agree to the Pentecostals of Hayward ("POH") Funeral Event Request terms *

I understand that this Funeral Event Request must be reviewed and approved by the Pastor before proceeding. The date(s), room(s) and resource(s), etc. may or may not be available and/or restricted based on scheduling. This request is subject to change.

By selecting the box below, you are stating that you understand and agree to the POH Security Deposit terms *

Applicant(s) will be required to provide POH Staff a detailed clean-up plan. To ensure the clean-plan is executed, a $300 Security Deposit will be required from the Applicant(s), which is to be paid upon approval of this Funeral Request.

By selecting the box below, you are stating that you understand and agree to the POH Interview Process terms *

Applicant(s) will be required to undergo an in-person interview with the Pastor. Applicant(s) will also be required to submit the intended Guest List for the Funeral Event. The Applicant(s) must undergo the interview process and submit the Funeral Guest List before this Request can be approved.