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Prayer Request Form
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* Indicates required question
Your First Name:
*
Your answer
Your Last Name:
*
Your answer
Phone Number:
*
xxx-xxx-xxxx
Your answer
Email Address:
*
Your answer
Retype Email Address:
*
Your answer
Address:
*
Your answer
City:
*
Your answer
State/Province/Region:
*
Your answer
Zip/Postal Code
*
Your answer
The person to be prayed for is:
*
Me
A family member
Someone else
Is this person a member of Prairie Avenue Christian Church?
*
Yes
No
I'm not sure
Please describe the prayer request:
Your answer
Which of the following best describes this prayer request?
Addiction/Recovery
Cancer
Child/Youth
End of Life Concerns
Finances/Employment
Gratitude
Grief
Health and Healing
Marriage/Relationships
Mental Health
Other
Spiritual Guidance
Surgery
Clear selection
Would you like someone from Congregational Care to follow up with you regarding this request?
*
Choose
Yes, by email.
Yes, by phone.
No, I would not like a follow up (prayer only.)
I am entering this as a prayer group volunteer.
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No
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