Bereavement Form

Our hearts go out to you in your time of loss.

Please share details below, so we can notify our clergy and community.

* Your Loved One's Name

Their Hebrew Name (if applicable)

* Their Date of Birth

* Their Gender

* Their Date of Death

Did the death take place before/after sunset (optional)

Their Age

Where Did They Live?

* Your First Name

Your Last Name

* Your Relationship to the Deceased

If "Other" please specify relationship

* Are You the Primary Contact?

Your Email

Your Phone Number

If no, Who is the Primary Contact?

Email of Primary Contact

Mobile Number of Primary Contact

* May we send a community notification?

* Are there additional family members to list on the notification?

Additional Family Members
Please select the "relationship category" and list all family members. If you need additional types, please add it in the "Additional Information" box at the bottom.

Survived By: Relationship to the Deceased

Survived By: List Name(s)

For Partners of the Bereaved Family Member, please put the name in (parenthesis)
Ex: John (Jane) Smith

Survived By: Relationship to the Deceased

Survived By: List Name(s)

For Partners of the Bereaved Family Member, please put the name in (parenthesis)
Ex: John (Jane) Smith

Survived By: Relationship to the Deceased

Survived By: List Name(s)

For Partners of the Bereaved Family Member, please put the name in (parenthesis)
Ex: John (Jane) Smith

Survived By: Relationship to the Deceased

Survived By: List Name(s)

For Partners of the Bereaved Family Member, please put the name in (parenthesis)
Ex: John (Jane) Smith

Preceded in Death By:

If you need to list more than 2 types of relationship, please use the additional notes field at the bottom of the form.

Preceded By: Relationship to the Deceased

Preceded By: List Name(s)

Preceded By: Relationship to the Deceased

Preceded By: List Name(s)

Additional Relationships to List

Funeral & Shiva Information

* Publicly Share Funeral/Shiva Information?

Type of Service

Location of Service

Cemetery Name and City
If not yet known, please leave blank.

Date of Service

If not yet known, please leave blank.

Time of Service

If not yet known, please leave blank.

Will CBI Clergy be officiating?

Are you planning to live-stream the service?

Will there be a "meal of condolence" following the service?

Meal of Condolence Location

Leave Blank if not set yet

* Will there be shiva?

* If yes, please specify the dates/times/locations that you plan to hold shiva minyans.

Have you spoken with the CBI Clergy to coordinate shiva leaders?

Date of Shiva - 1 Night

Leave Blank if not set yet

Time of Shiva - 1 Night

Leave Blank if not set yet

Location of Shiva - 1 Night

Leave Blank if not set yet

CBI Clergy Officiating Shiva - 1 Night?

Leave Blank if not set yet

Name of CBI Clergy Leading Shiva - 1 Night?

Leave Blank if not set yet

Date of Shiva - 2nd Night

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Time of Shiva - 2nd Night

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Location of Shiva - 2nd Night

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CBI Clergy Officiating Shiva - 2nd Night?

Leave Blank if not set yet

Name of CBI Clergy Leading Shiva - 2nd Night?

Leave Blank if not set yet

Date of Shiva - 3rd Night

Leave Blank if not set yet

Time of Shiva - 3rd Night

Leave Blank if not set yet

Location of Shiva - 3rd Night

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CBI Clergy Officiating Shiva - 3rd Night?

Leave Blank if not set yet

Name of CBI Clergy Leading Shiva - 3rd Night?

Leave Blank if not set yet

Date of Shiva - 4th Night

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Time of Shiva - 4th Night

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Location of Shiva - 4th Night

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CBI Clergy Officiating Shiva - 4th Night?

Leave Blank if not set yet

Name of CBI Clergy Leading Shiva - 4th Night?

Leave Blank if not set yet

Date of Shiva - 5th Night

Leave Blank if not set yet

Time of Shiva - 5th Night

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Location of Shiva - 5th Night

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CBI Clergy Officiating Shiva - 5th Night?

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Name of CBI Clergy Leading Shiva - 5th Night?

Leave Blank if not set yet

Date of Shiva - 6th Night

Leave Blank if not set yet

Time of Shiva - 6th Night

Leave Blank if not set yet

Location of Shiva - 6th Night

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CBI Clergy Officiating Shiva - 6th Night?

Leave Blank if not set yet

Name of CBI Clergy Leading Shiva - 6th Night?

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Additional Information

On which date will you observe the "yahrzeit"

Please share a remembrance of your loved one to be added to the announcement

Please upload a photo of your loved one to be included in the email.

Thu, December 26 2024 25 Kislev 5785

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