Simply Cremations

Today's Date *

Name of Funeral Service Provider *

Address of Funeral Service Provider *

Name of Crematory *

Please Select one of the Following: I have been given the opportunity to personally identify the above named deceased, and of a representative I have chosen, has made such identification and authorize the above named Funeral Service Provider to transfer deceased to the above named crematorium.
No identification was made and hereby waive such identification.
*

If you have seen and selected a casket/ container for the purpose of cremating the body of the above named and deceased person, please enter the name and description of the casket/ cremation container *

If you have seen and selected an urn/ container for the purpose of holding the above named deceased cremated remains, please enter the name and description of the urn/ container. *

(1) The Crematory Operator makes every reasonable effort to remove all the cremation remains but it is impossible to remove all of them, as some dust and other residue from the cremation process is always left in the cremation chamber. In addition, while every reasonable effort will be made to avoid commingling, inadvertent or incidental commingling of minute particles from previous cremations is a possibility. I, the authorized representative, understand and accept this fact.

(2) I hold the Funeral Service Provider, Cremation Operator or Funeral Director, harmless for the personal belongings left in the cremation casket/ container.

(3) I, the authorized representative certify that I have the right under "Alberta Regulation 226/1998" provisions of section 36 of the Funeral Services Act, General Regulation, to authorize the cremation and disposition of the cremated remains of the above named deceased subject to the Act, the regulations and the By-laws of the Crematorium. I agree to indemnify and hold harmless the Crematorium and the Funeral Service Provider, their officers and employees for any liability, costs, expenses, or claims resulting from this cremation and disposition authorization. I also hereby give permission to the Funeral Service Provider to remove any implanted Pacemaker and/or Artificial Limbs and dispose of same prior to cremation.

I fully understand all of the above information and agree to these terms. (please check the circle to the right to verify that you fully understand and agree to all of the above information. *

Are there any surgical Implant or batter operated devices in/with the body? These devices will explode during the cremation process and cause damage to our equipment and/or create an unsafe work environment for our staff. I understand that I am liable for any damage or injury that I cause if I fail to disclose any such device. No Implants Yes, Pacemaker Yes, Defibrillator Yes, Artificial Limbs Yes, Radiological Implants *