Advance After-Death Care Directive (Addendum to Will) (For adults, aged 18 and up)
Name _________________________________________________________________
Address ________________________________________________________________
Phone & Email __________________________________________________________
Identify your Environmental Values
Rank your environmental values by #1-5 with the list below of what is most important to you:
_____ Minimize pollution and pesticide use and reduce carbon emissions for future generations
_____ Preservation of land for green and sustainable use
_____ Restore habitat for native flora and fauna
_____ Offering of my body to Nature for tree memorial and fertility of soil
_____ Other _______________________________________________________________
Identify your Financial Concerns
_____ Forgo expensive funeral add-ons (casket, vault, funeral home use, etc.)
_____ Opt out of memorial or have a home vigil
_____ Opportunity to have shared designated couple or family plot
_____ Simple shroud or basic casket with graveside burial
_____ Save 10-20% by advance payment for plot(s)
Identify your Spiritual or Religious Values
_____ Participation of family and friends in a vigil, memorial or celebration of life
_____ Have my rabbi, minister or spiritual leader conduct religious rites of passage and memorial
_____ Create an authentic spiritual experience around my passage and have my family supported in their grief process, allowing natural sharing of memories and grief
_____ Bringing nature to my graveside burial, acknowledging the greater cycle of life and death
_____ Other ________________________________________________________________
Name and contact information for friend, family member or pastor/rabbi whom I have chosen to handle my funeral, memorial, vigil, or graveside burial:
________________________________________________________________________________________
Name and contact information for person I would like to acquire my Death Certificate:
________________________________________________________________________________________
Green burial choices
_____ John Muir Memorial Green Burial Sanctuary
_____ companion or shared plot already on site
_____ family plot on site
Funeral or Vigil Choices
_____ Home funeral (family members are handling arrangements)
_____ Memorial at John Muir Memorial Green Burial Sanctuary
_____ Church, temple or funeral home
_____ Direct burial with no funeral
_____ Other ___________________________________________________________
Container choices
_____ Simple shroud (cotton – silk – linen)
_____ Biodegradable casket (wood – pine – cardboard – willow – bamboo)
_____ Homemade or purchased privately
_____ Direct burial with no covering or container
_____ Other ___________________________________________________________
_____ Biodegradable urn for cremains (cremation remains)
I wish to have my burial container or shroud obtained from: ______________________
______________________________________________________________________
Memorial or Celebration of Life location
_____ John Muir Memorial Green Burial Sanctuary
_____ Other ___________________________________________________________
Preparation of My Body
After my death, I wish to have my body prepared or temporarily preserved:
_____ Preparations and ritual washing by my religious providers
_____ Preparation and washing at home by friends or family
_____ Dry ice
_____ Refrigeration
I wish to have my body prepared or dressed in the following way:
___________________________________________________________________________________
I wish to have the following biodegradable items placed with me in my casket or burial plot:
___________________________________________________________________________________
Marking my grave
I wish to have
_____ A native tree planted as a marker (with small metal engraved hanger)
_____ No marker
_____ A rock or flat engraved field stone (if in the Memorial garden only)
_____ My name and dates listed on a central wall marker
_____ Wildflowers or native plants planted over my grave (if grave is in the Meadow)
_____ GPS location only and contained in Sanctuary office file
_____ Other __________________________________________________________
Transportation of my body
_____ From home to the Sanctuary
_____ From funeral home to the Sanctuary
_____ From hospice or hospital to the Sanctuary
_____ From an airport to the Sanctuary
Obituary
_____ I or my family member will write my obituary
_____ I would like John Muir Memorial Green Burial Sanctuary to write and publish my obituary on their website
Vital Statistics (for filing Death Certificate and Obituary only):
Date of birth _________________ Place of birth _________________________________
Marital status ________________ Gender _________________________________
Spouse or partner’s name and contact information _________________________________
Education ______________________________________________________________
Profession ______________________________________________________________
Spiritual or community organizations or volunteering _______________________________
__________________________________________________________________________
__________________________________________________________________________
Family/friends (who may survive you)and their contact information:___________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Important life events or wishes I would like written in my obituary: ___________________
___________________________________________________________________________________
Please copy and distribute this Plan to:
_____ Family member (contact information:) _____________________________________
_____ Friends (contact information:) ____________________________________________
_____ Attorney (contact information:) ___________________________________________
_____ Estate planner (contact information:) _______________________________________
_____ End of life planner (contact information:) ___________________________________
_____ Rabbi, minister (or other spiritual/religious contact:) ____________________________
Signature ____________________________ Printed legal Name______________________
Date ________________________________