Sickness and Distress Notification Form Please complete the form with the specific information requested, do not attempt to add information not asked for in the form, for example in visitation, put ONLY date and hours, do not add in any details. NOTICE: It is the Reporters Responsibility to be sure that the person named (or family in case of death) is in agreement to have the information posted.Date Submitted *Name of member sick or deceased *Is This a Member of the Lodge or Chapter:YesNoPlease Provide Details of Distress Report:Members Should Send Card To:IF DEATH, PLEASE PROVIDE DEATH SERVICES DETAILS:Date of Passing:Date and Time of Visitation:Date and Time of Service:Funeral Home Info:Your Contact InfoNameAddressEmailPhoneSubmitPlease do not fill in this field. Our Unique ValueDiscover what sets Braintree Moose apart from the rest Community CareWe are committed to serving those in need within our local community and providing care for children at Mooseheart and seniors at Moosehaven. Family ActivitiesJoin a wide array of activities for individuals and families, including holiday parties, themed dinners, sports, and live entertainment. Life CelebrationAt Braintree Moose, we believe in celebrating life together, supporting our members, and uniting communities for a brighter future. Get Involved TodayJoin us in our mission of caring for the young and old, uniting communities, and celebrating life together with the Moose Organization.BECOME A MOOSE
