Bikur Cholim Brigade ("BCB") Care Package Request Form 5774
We are sorry to hear that you or a friend are feeling under the weather. Your YU community is here for you and davening for your Refuah Shleimah. As a small expression of our care, please fill out this form to request a care package, sponsored by your student councils.  For further support and for questions, please email us at bcb@yu.edu or visit https://www.yu.edu/bcb 
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What is your relationship to the under the weather student? *
Does the student you are requesting for live in the dorms? *
If you are requesting on behalf of another student, are you willing to deliver the care package to him? *
What is your Name? *
What is your Phone Number? *
What is your email?
Feel free to add (either here on the form or in the group linked below) the student's Hebrew name to a YU community Tehillim Group for Refuah Shleimahs. The YU community will daven for the student's Refuah Sheleimah: 
https://abrahams.page.link/QDLB8sBpqHj2zuZV8 (links to the free mobile App Tehillim platform)
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