Embalming Authorization Form

If the initial authorization for embalming was given orally fill in the information below.

The REPRESENTATIVE warrants and represents to FUNERAL HOME that the REPRESENTATIVE is the person or the appointed agent of the person who by law has the paramount right to arrange and direct the disposition of the remains of the DECEDENT and that no other person(s) has a superior right over the right of the REPRESENTATIVE.

The REPRESENTATIVE authorizes and directs the FUNERAL HOME, its employees, independent contractors, and agents (including apprentices and/or mortuary students under the direct supervision of a licensed embalmer), to care for, embalm, perform restorative measures, and prepare the body of the DECEDENT. The REPRESENTATIVE acknowledges that this authorization encompasses permission to embalm at the FUNERAL HOME facility or at another facility equipped for embalming . In providing this authorization , REPRESENTATIVE acknowledges that embalming is not an exact science and that results may be adversely impacted by a number of factors, including, but not limited to the conditions under which the death occurred, time lapse between death and the onset of the embalming procedure , physical condition at the time of death, medications , especially analgesics administered prior to death, life-saving procedures, cause of death, storage procedures of the releasing institution, natural elements, tissue/organ donations, and post-mortem (autopsy) examinations.

The REPRESENTATIVE agrees to indemnify and hold harmless the FUNERAL HOME from any claims or causes of action arising or related in any respect to this embalming authorization or the FUNERAL HOME's reliance thereon.