Elemental Cremation & Burial

AUTHORIZATION TO EMBALM

Disposition Authorization

Name of Decedent: [calc_name]

Date of Birth: [DOB]            Date of Death: [DOD]

Notice: This is a legal document that contains important provisions concerning cremation. Please read this entire document carefully before signing. Cremation is an irreversible and final process.

I, the undersigned (the “Authorizing agent”) hereby authorize and request ELEMENTAL CREMATION & BURIAL, their agents and employees, to embalm and process the human remains of the Decedent.

Embalming is a temporary preservation of the body using chemicals designed for this purpose as well as other procedures that may be invasive to the body.  If Embalming is selected by the next-of-kin or agent of deceased, they authorize and direct ELEMENTAL Cremation & Burial, its employees, independent contractors, and agents (including interns and/or mortuary students under the direct supervision of a licensed embalmer), to care for, embalm, and prepare the body of the Deceased. The next-of-kin or agent acknowledges that this authorization encompasses permission to embalm at the ELEMENTAL Cremation & Burial facility or at another facility equipped for embalming. In providing authorization, next-of-kin or agent acknowledge that embalming is not an exact science and that results are dependent upon 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, life-saving procedures, cause of death, storage procedures of the releasing institution, natural elements, tissue/organ donations, and post-mortem (autopsy) examinations.

 

The next-of-kin or agent agree to indemnify and hold harmless ELEMENTAL Cremation & Burial from any claims or causes of action arising from or related to this authorization for embalming, or ELEMENTAL Cremation & Burial reliance upon this authorization.

SIGNATURE OF AUTHORIZED AGENT:  ________________________________________

[Firstname, Lastname, Relation]