Prayer Concern Submission

Your Name *
Current Email or Phone Number *
Your Relationship to the Individual *
Are You Submitting Notice About a Death or Illness? *
Name of Individual (Who is Ill or Who has Died) *
Prefix
First
First
Last
Last
Do You Have the Individual's or Family's Permission to Submit this Prayer Request? *
Prayer requests are sent out via a mass email and some people do not want personal information communicated in this way. If you check no, we will just share this information internally with staff for prayer support.
Details *
ILLNESS: Please include what the individual would like communicated: type of illness, hospital or hospice location, etc. DEATH: Please include visitation and service information, an address for condolences and any memorial requests. (We generally do not send out messages about someone passing until we have this information.)
Do You Have an Obituary Link? If So, Please Provide Below. *
Where May Get Well Cards or Condolences Be Sent? *