JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
What's On Your Heart?
Please feel free to share what's on your heart and indicate how you would like to be supported.
Sign in to Google
to save your progress.
Learn more
What's on your heart?
Your answer
Would you like to be contacted by Pastoral Care?
Yes
No
Clear selection
Would you like to be contacted by a Minister?
Yes
No
Clear selection
Name
Your answer
Contact Info (phone, email)
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Unitarian Universalist Congregation of Fairfax.
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report