McCoy & Harrison Funeral Home

Cremation Family Authorization Form


CHAPEL OF THE PINES
CEMETERY & CREMATORY

503 FM 1942 Crosby, Texas 

281-328-1000

 

Cremation Authorization Form
IDENTIFICATION 

Name of Decedent:

Date of Death:

Time of Death:  

Place of Death:

Sex:  

Age:  

Was the death caused by an infectious or contagious disease?  

If yes, please explain.

PLEASE NOTE: CHAPEL OF THE PINES CREMATORY STRICTLY ADHERES TO THE GUIDELINES SET FORTH IN TEXAS VERNONS CODE. NO EXCEPTIONS WILL BE GRANTED OR ALLOWED

 

LIMITATION OF LIABILITY 

As the Authorizing Agent(s), 1 (we) hereby agree to indemnify, defend, and hold harmless Chapel Of The Pines Crematory, its officers, agents and employees, of and from any and all claims, demands, causes or causes of action, and suits of every kind, nature and description, in law or equity, including any legal fees, costs and expenses of litigation, arising as a result of, based upon or connected with this authorization, including the failure to properly identify the decedent or the human remains transmitted to Chapel Of The Pines Crematory, the processing, shipping and final disposition of the decedent's cremated remains, the failure to take possession of or make proper arrangements for the final disposition of the cremated remains, any damage due to harmful or explodable implants, claims brought by any other person(s) claiming the right to control the disposition of the decedent or the decedent's cremated remains, or any other action performed by Chapel Of The Pines Crematory, its officers, agents, or employees, pursuant to this authorization, excepting only acts of willful negligence. 

 

SIGNATURE OF AUTHORIZING AGENT 

THIS IS A LEGAL DOCUMENT. IT CONTAINS IMPORTANT PROVISIONS CONCERNING CREMATION. CREMATION IS IRREVERSIBLE AND FINAL... READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. 

By executing this Cremation Authorization Form, as Authorizing Agent(s) the undersigned warrant that all representations and statements contained on this form are true and correct, that these statements were made to induce Chapel Of The Pines Crematory to cremate the human remains of the decedent, and that the undersigned have read and understand the provisions contained on this form. 

Executed at: , this day of November 30, 2020

Name:  

Signature: Please see the signature at the bottom part of the document.

Relationship to Decedent:

Phone Number:

Address:  

 

PACEMAKERS, PROSTHESES, AND RADIOACTIVE IMPLANTS 

Please initial one of the next two paragraphs. 

  The decedent's remains do not contain a pacemaker, radioactive implant or any other device that could be harmful to the crematory. They are safe to cremate. 

  The following list contains all existing devices (including all mechanical, radioactive implants and prosthetic devices) which are implanted in or attached to the decedent, that should be removed prior to cremation


I have instructed the funeral home to remove or arrange for the removal of these devices and to properly dispose of them prior to transporting the decedent. 

 

ALL PACEMAKERS AND RADIOACTIVE IMPLANTS MUST BE REMOVED PRIOR TO DELIVERING THE DECEDENT
 

Signature of Funeral Director as Witness for Signature(s) of Authorizing Agent(s): Please see the signature at the bottom part of the document.

Name of Funeral Home or Other Establishment:  
Address of Funeral Home or Other Establishment:  
Phone Number :  

Date cremation received:
Date of cremation:
Signature of person picking up remains: Please sign at the bottom part of the document.
Relationship:  

 

CHAPEL OF THE PINES CREMATORY
POLICIES, PROCEDURES, AND REQUIREMENTS 

The cremation, processing and disposition of the remains of the deceased shall be performed in accordance with all governing laws, and the policies, procedures and requirements of Chapel Of The Pines Crematory and the designated funeral home. 

This document describes many of the policies and requirements of Chapel Of The Pines and is incorporated in our Cremation Authorization Form. We suggest you take the time to read this document carefully before executing the Cremation Authorization Form.

 

CREMATORY'S REQUIREMENTS FOR CREMATION

Cremation will take place only after all the following conditions have been met. 

  1. Any scheduled ceremonies or viewings have been completed. 
  2. Civil and medical authorities have issued all required permits. 
  3. All necessary authorization have been obtained. 
  4. A cremation permit from Bureau of Vital Statistics accompanies this document. 

 

CASKETS/CONTAINERS 

Crematory requires either a casket or an alternative (cremation) container for cremation. All caskets and alternative containers must meet the following standards: 1) be composed of materials suitable for cremation; 2) be resistant to leakage or spillage; 3) be sufficient for handling with ease: and 4) be able to provide protection for the health and safely of crematory personnel. 

Many caskets that are comprised primarily of combustible material also contain some exterior parts, e.g. decorative handles or rails, that are non-combustible and that may cause damage to the cremation equipment. Chapel Of The Pines, at its sole discretion, reserves the right to remove these non-combustible materials prior to cremation and to discard them with similar materials from other cremations and other refuse in a non-recoverable manner. 

Crematory will not accept remains to be cremated in a metal casket.

 

PACEMAKERS, PROSTHESES, AND RADIOACTIVE DEVICES 

Pacemakers and prosthesis, as well as any other mechanical or radioactive devices or implants in the decedent, may create a hazardous condition when placed in the cremation chamber. It is imperative that pacemakers and radioactive devices be removed prior to cremation. If the funeral home is not notified about such devices and implants, and not instructed to remove them, then the person(s) authorizing the cremation will be responsible for any damages caused to Chapel of The Pines or crematory personnel by such devices or implants. 

 

THE CREMATION PROCESS 

ALL CREMATIONS ARE PERFORMED INDIVIDUALLY

Cremation is performed by placing the deceased in a casket or other container and then placing the casket or other container into a cremation chamber or retort where they are subjected to intense heat and flames. During the cremation process, it may be necessary to open the cremation chamber and reposition the deceased in order to facilitate a complete and thorough cremation. Through the use of a suitable fuel, incineration of the container and contents is accomplished and all substances are consumed or driven off, except bone fragments (calcium compounds) and metal (including dental gold and silver and other nonhuman material) as the temperature is not sufficient to consume them. 

Due to the nature of the cremation process any personal possessions or valuable materials, such as dental gold or jewelry (as well as body prosthesis or dental bridgework), that are left with the decedent and not removed from the casket or container prior to cremation will be destroyed or if not destroyed, will be disposed of by Chapel Of The Pines. As the casket or container will not normally be opened by Chapel Of The Pines (to remove valuables, to allow for a final viewing or for any other reason), arrangements must be made with the funeral home to remove any such possessions or valuables prior to the time that the decedent is transported to Chapel Of The Pines. 

Following a cooling period, the cremated remains, which will normally weigh several pounds in the case of an average size adult, are then swept or raked from the cremation chamber. Chapel Of The Pines Crematory makes a reasonable effort to remove all of the cremated remains from the cremation chamber, but it is impossible to remove all of them, as some dust and other residue from the process are always left behind. In addition, while every effort will be made to avoid commingling, inadvertent or incidental commingling of minute particles of cremated remains from the residue of previous cremations is a possibility. 

After the cremated remains are removed from the cremation chamber, all non-combustible materials (in so far as possible), such as bridgework, and materials from the casket or container, such as hinges, latches nails, etc., will be separated and removed from the human bone fragments by visible or magnetic selection and will be disposed of by Chapel Of The Pines Crematory with similar materials from other cremations in a non-recoverable manner. 

When the cremated remains are removed from the cremation chamber, the skeletal remains often contain recognizable bone fragments. Unless otherwise specified, after the bone fragments have been separated from the other material, they will then be mechanically processed (pulverized). This process of crushing or grinding may cause incidental commingling of the remains with the residue from the processing of previously cremated remains. These granulated particles of unidentifiable dimensions will be virtually unrecognizable as human remains. 

URNS/CONTAINERS

After the cremated remains have been processed, they will be placed in the designated urn or container. Chapel Of The Pines will make a reasonable effort to put all of the cremated remains in the urn or container, with the exception of dust or other residue that may remain on the processing equipment. In the event the urn or container provided is insufficient to accommodate all of the cremated remains, the excess will be placed in a separate receptacle. The separate receptacle will be kept with the primary receptacle and handled according to the disposition instructions on the Cremation Authorization Form. Chapel Of The Pines requires that all urns or containers provided be appropriate for shipping or permanent storage, and that in the case for an adult, it is recommended that the urn or container be a minimum size of 200 cubic inches. If such an urn or container is not provided for the cremated remains, then Chapel Of The Pines will place the cremated remains in a plastic bag inside a corrugated paper container designed for shipping or storage. 

 

FINAL DISPOSITION 

Cremation is NOT final disposition, nor is placing the cremated remains in storage at a funeral home final disposition. The cremation process simply reduces the decedent's body to cremated remains. These cremated remains usually weigh several pounds and usually measure in excess of 150 cubic inches. Some provision must be made for the final disposition of these cremated remains. Therefore Chapel Of The Pines strongly suggests that arrangements for final disposition be made at the time that the cremation arrangements are made and that the Cremation Authorization Form is completed. 

If the final disposition of the cremated remains has not been completed within ten (10) days of the cremation, Chapel Of The Pines shall be authorized to arrange for the final disposition of the cremated remains in any manner permitted by law. Such final disposition may include the commingling of the cremated remains with other cremated remains, and thereafter the cremated remains of the decedent will not be recoverable. 

If the option selected for final disposition includes scattering, then the cremated remains will not be recoverable. If scattering is performed in a common area, then the cremated remains may be commingled with particles of other cremated remains that have been previously scattered. 

 

LIMITATION OF LIABILITY

The obligations of Chapel Of The Pines shall be limited to the cremation of the decedent and the disposition of the decedent's cremated remains as authorized on the Cremation Authorization Form. No Warranties Express or implied are Made and Damages Shall be Limited to the Amount of the Cremation Fee Paid.

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Signed by Brandon Lee
Signed On: November 18, 2020

McCoy & Harrison Funeral Home https://www.mccoyandharrison.com
Signature Certificate
Document name: Cremation Family Authorization Form
lock iconUnique Document ID: d19cf0cbf2a20c0cf07470ba970d950b59d4ffa3
Timestamp Audit
November 15, 2020 11:16 pm CSTCremation Family Authorization Form Uploaded by Bayne Parker - bayne@baynedm.com IP 110.54.240.123