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Justice of the Peace Questionnaire
In order to create the best ceremony for you, please fill out the questionnaire below. Please advise me if anything changes. I would appreciate your sending me a copy of your photo IDs (scan/e-mail, fax, or regular mail).
Mary Pugh
Norwalk, CT 06854
203 838 1038
cell 203 434 5038
fax 206 984 4343
mary@ctjusticeofpeace.com
Contact Information
First Name:
Last Name:
Address:
City:
State:
Zip-Code:
Phone:
Alternate Phone:
E-Mail:
I am the:
Bride/Partner
Groom/Partner
Friend/Family
Couple Information
Bride/Partner 1 First Name:
Bride/Partner 1 Middle Name:
Bride/Partner 1 Last Name:
Bride/Partner 1 Preferred Name:
Groom/Partner 2 First Name:
Groom/Partner 2 Middle Name:
Groom/Partner 2 Last Name:
Groom/Partner 2 Preferred Name:
Ceremony Information
Type of Ceremony:
Wedding
Civil Union
Wedding Celebration
Vow Renewal
Commitment Ceremony
Ceremony Date:
August 2008
S
M
T
W
T
F
S
31
27
28
29
30
31
1
2
32
3
4
5
6
7
8
9
33
10
11
12
13
14
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34
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19
20
21
22
23
35
24
25
26
27
28
29
30
36
31
1
2
3
4
5
6
Start Time:
07:00
07:15
07:30
07:45
08:00
08:15
08:30
08:45
09:00
09:15
09:30
09:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
End Time (Approx):
07:00
07:15
07:30
07:45
08:00
08:15
08:30
08:45
09:00
09:15
09:30
09:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
Ceremony Location:
Address:
City:
State:
Zip-Code:
Phone # at Location:
There is a ceremony rehearsal that we would like you to attend
Ceremony Specifics
Ceremony Size:
Couple Only
Fewer Than 10 Guests
11-50 Guests
Over 50 Guests
Formality of Ceremony:
Informal
Formal
Religious Preferences For Ceremony:
Not Religious
Spiritual but not religious
Some reference to religion
Religious (specify faith(s))
Other (Please Specify)
Other (From Above):
Ceremony Attendants (Check all that apply):
Best Man
Ushers
Ring Bearer
Maid of Honor
Brides Maids
Flower Girl
Pets
Other (Please Specify)
Other Attendants:
Bride/Partner Given Away
by
Number of Guests:
Rings:
Dual Rings (Both will give and receive a ring)
Single Ring (Bride/Partner 1 will receive a ring)
Single Ring (Groom/Partner 2 will receive a ring)
No Rings
Ceremony Options (Check all that apply):
Unity Candle (Couple to provide candle setup)
Unity Candle (JP to provide candle setup)
Rose Ceremony (Couple to bring roses)
Jumping of the Broom (Couple to bring broom)
Breaking of the Glass (Jewish ceremonies, couple provides setup)
Sand Ceremony
Wine Ceremony
Bread Ceremony
Passing of the Rings Ceremony
Hand Blessing Ceremony
Other Option (Please Specify):
Vows
Sample vows are on the CD I send to my couples but also are available at www.marypugh.com/vows for your reference. You are not limited to selecting from these sample vows; you can have totally customized vows if you prefer. If you write "private personal vows" I ask that you e-mail them to me separately.
Selected Vow (From the CD/Site):
01 Brief Ceremony
02 Civil Wedding Ceremony
03 Classy simple Wedding Ceremony
04 Contemporary non-religious Ceremony
05 Enter Days of Togetherness
06 Simple Religious Ceremony
07 Witness and Share the Joy
08 French and English Brief Ceremony
09 Marriage is promise of Love
10 May This Day Shine Eternally
11 Short Marriage Ceremony
12 Simple Civil Wedding
13 a or b Spanish English Ceremony
14 Traditional Christian- More formal Ceremony
15 Very Short Wedding Ceremony
16 Wedding Ceremony of Bride and Groom
17 Wedding Vows - RENEWAL Ceremony
18 Welcome to the Celebration
19 When Love Beckons
20 Jewish Marriage Ceremony
21 Elegant Wedding Ceremony
22 Wedding Ceremony with Rose Ceremony
23 Commitment Ceremony
Custom/Other (Upload Below)
Readings Planned by Family/Friends:
Other Details
I would be happy to help you obtain your license. See my website for details http://www.ctjusticeofpeace.com/license.php You will need my contact info above for the town hall application. Also, I would appreciate your mailing a copy of your photo id (DR License, passport first page, etc) to my address above.
Do you have your license?
Yes (Please indicate town of issuance and date next)
No (see http://www.ctjusticeofpeace.com/license.php for information)
What would you like your JP to wear (Check all that apply):
Black Pant Suit
White Robe
Black Robe
Other (Specify Below)
Other (From Above):
Stole Color:
Gold
Silver
Red
Blue
White
Green
Purple
(None)
Comments/Special Requests:
May we have permission to utilize photogragh(s) of you and/or your ceremony on our website, advertising, and listings?
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