117 Holt Drive
Madison, IN 47250
Phone: (812) 265-4021
Fax: (812) 265-2133

Online Pre-Planning Form

The Important Details

About Your Animal Companion

This plan is for a

If "Other", please specify the type of animal:





About You

First Name:           

Middle Name:       

Last Name:           

Daytime Phone:     

Evening Phone:      




Your Pet's Final Arrangements

I request the following care for my pet

Private Cremation

     Do you wish to have the ashes returned to you?



     Please read the following, checking the acknowledgement box to the left afterwards:

       If you do not wish the ashes returned, I realize they will be scattered, or communally interred in a   

            fitting location with the remains of other unclaimed pets.

Communal Cremation

     Please read the following, checking the acknowledgement box afterwards:

       I realize that in communal pet cremations, the ashes cannot be returned to me, and will be interred

            communally, or scattered, by a member of the staff.

     If this is your preference, then where will inter your pet's remains?

         My Home

         Friend or Relative's home




          Pet Cemetery




      For burial, will you want a casket to protect your pet's body?



The Remembrance Service

Will you want a visitation- a last time get together with your pet?



Many families also wish to have a remembrance service, where family and friends can come together to
pay their respects, and support you in your loss. Do you wish to have a service of remembrance for your



If appropriate, please add the following details:

Where should the remembrance service be held?

Who should be there?

Please enter the names of the guests you’d wish to invite. The list will only act as a reminder for us,
when it comes time to extend the invitations.

Would you like to incorporate ceremonial activities during this time? Please check the appropriate

           Special readings of poetry or prose


           The planting of a tree/flower/bush

           Scripture readings

           Candle lighting

           A charitable donation drive for a local shelter in memory of your pet

           A memory table with photographs, your pet’s favorite toys–anything tangible that was a big part
               of their life.

           Writing, and reading aloud, a eulogy to your pet

Do you have any specifics to share, such as the name of the poem, musical selection, or preferred



If you answered “yes”, please provide the details below :

Your Pet's Memorial

Just like the decisions you made earlier, making a decision about memorializing your pet is a very
personal process. Your final selection should reflect the life shared with your pet, your life style, your
personal style, and those “little things” which reflect your pet’s unique personality.

Do you wish to create memorial in honor of your animal companion?



Ideally, where would you like this memorial?

            Inside my home

            In my garden


If “other”, please specify your desired location:

Please let us know what memorialization or remembrance products you’d be most interested in:

            Personalized rocks/garden flagstones

            Bird feeders

            Jewelry personalized with your pet’s paw or nose print

            Locket jewelry for a portion of your pet’s cremated remains or fur

            Personalized remembrance candles

            Personalized memory boxes and books

Your Pet’s Story

Here’s the place where you shine a spotlight–lovingly–on your pet’s life story. The information you
include here will help us to create your pet’s online Tribute, and will be integral in creating a fitting
Remembrance Ceremony for your beloved animal companion.

Birthdate/Adoption date:                

Date of death (if applicable):          

Location of birth or adoption:         


Names of “Pet Parents”:                

Siblings—Pet and Human:              

Favorite Toy(s):                             

Favorite Activity(s):                       

Least Favorite Thing(s):                 

Other Friends:                               

Favorite Place to Sleep:                 

Favorite Food:                               

Favorite Memories:

“As I am to spend the next four months or so providing transitional and then hospice care for my
beloved terrier, Courage; I can’t tell you how important it has been to have this resource available to
me. Your online pre-planning information and form made it very simple to understand the importance
of providing him with the same quality of care after his passing as I’ve done throughout the almost
fourteen years we’ve been together. Thank you for that. It’s quite a gift to us both.” ~ Kim Stacey,
Boulder Creek, California

You’re Done!

When you click the “submit” button, your pre-plan will be transmitted to us via email. Before you go,  
please select one of the following options:

           Send me additional information on your services

           Contact me to schedule an appointment

           Place my pet’s information on file