Personalized Memorial Song Questionnaire

About your loved one

1. What was your loved one’s full name?

2. What name or nickname should we use in the song?

3. How would you describe them in a few words?

Examples: hardworking, funny, stubborn, loving, faithful, adventurous, family-oriented.

4. Where were they from, and was there a place that was especially important to them?

Examples: hometown, family farm, lake, church, front porch, favorite vacation spot.

Their story

5. What are some important parts of their life story?

Examples: childhood, career, military service, marriage, raising children, overcoming hardships, retirement.

6. What kind of work did they do? Were they especially proud of it?

7. Who were the most important people in their life?

Please include names and relationships you’d like mentioned.

8. Tell us about their spouse or significant other, if you’d like them included.

How did they meet? How long were they together? What made their relationship special?

9. Tell us about their children, grandchildren, great-grandchildren, or other family members you’d like represented in the song.

In what order did the children come? How old was your loved one when they had each child? Where were they in life when each child was born?

The little things

10. What did they love doing?

Examples: fishing, hunting, cooking, farming, traveling, watching ball games, working on cars, gardening, playing with the grandkids.

11. What are the little things everyone will remember about them?

Examples: their favorite chair, morning coffee, an old truck, a certain hat, their laugh, Sunday dinners, sitting on the porch.

12. Did they have a favorite saying, joke, expression, or piece of advice?

13. Is there one memory or story that perfectly captures who they were?

Faith & values

14. Was faith important to your loved one?

Yes No Prefer not to include it

If yes, is there anything you’d specifically like included? Examples: Jesus, God, Heaven, prayer, church, a favorite Bible verse, being reunited with family.

15. What values or lessons did they leave behind?

Their song

16. What style of music would best represent them?

Other style

17. What feeling should the song have?

Emotional & heartfelt Celebration of life Peaceful & comforting Faithful & uplifting Powerful & inspirational A mixture

18. Would you prefer the vocalist to sound primarily:

Male Female Duet No preference

19. Is there anything you definitely WANT mentioned in the song?

20. Is there anything you DO NOT want mentioned?

Final message

21. If you could say one final thing to your loved one—or have them remembered for one thing—what would it be?

One last question

22. As the spouse or child of your loved one, write one or more paragraphs telling the story of their life from beginning to end.

Example: James grew up in Louisville as the oldest of four children, where he learned early to work hard and take care of his family. He met Mary after high school, married her at 22, and together they raised three children: Sarah, Michael, and Emily. He spent 35 years working as a plumber, coached Little League, loved fishing at Rough River, and never missed a Sunday dinner with his family.

Later in life, James became Papaw to six grandchildren and retired to enjoy his garden, front porch, and time with Mary. He faced every hardship with faith and courage. From the young boy who helped his parents to the husband, father, and grandfather who held his family together, James lived a life built on love, laughter, and always showing up for the people who needed him.

Service information

Funeral Home Family Contact Date Needed

Will the song be played during the service?

Yes No Not sure

Additional notes

Family authorization

I confirm that I am authorized to submit the information in this questionnaire and request creation of the memorial song. I give Dana Productions and the participating funeral home permission to use the information, names, memories, and materials I provide solely to create, revise, deliver, and present the requested song and related keepsake materials. I understand that the song is an artistic interpretation. Details may be shortened, rearranged, or expressed creatively to fit the music. I will identify any information that must be omitted or handled carefully. I understand that requested revisions, delivery timing, private family use, public sharing, and any promotional use are governed by the order terms. Dana Productions may not publicly post the song, the family's story, or identifying materials without separate written permission.

Printed name Relationship to loved one Date

Signature

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