Prayer Request Form

Complete and submit this form to request the addition of one or more names, or the continuation of one or more previously-submitted names, to the Prayer List that is published weekly.

Your name

*

Your email address

*

This address will receive a confirmation email

Your phone number(including area code)

*

Full Name of person(s) needing prayer

*

Person(s) being prayed for is/are

*

Please select all that apply.

Grace Parishioner Parishioner's Family Parishioner's Friend Other

If parishioner, family or other, what relationship?

Reason for request

*

Please select all that apply.

Sickness Hospitalization/Surgery Death Travel Thanksgiving Other

Date and Location of Hospitalization/Surgery (if applicable)

Departure and Return Dates for travel (if applicable)

Include this prayer request in church bulletin?

*

Please select all that apply.

Yes No

If yes, for how long?

Please select all that apply.

1 week 1 Month 3 Months

For a time longer than three months, please reach out to a member of the clergy.

Additional Information

Description

Complete and submit this form to request the addition of one or more names, or the continuation of one or more previously-submitted names, to the Prayer List that is published weekly.

Please Fix the Following

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