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Prayer Quilt Request
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* Indicates required question
Requesting Person
*
Your answer
Phone Number
*
Your answer
Can you receive a text
*
Yes
No
Email
*
Your answer
Person to receive the Prayer Quilt?
*
Your answer
What are the requested prayers for (diagnosis, condition, surgery)?
*
Your answer
Requested Prayers
*
Your answer
Preferred colors (if available)
*
Your answer
I have asked if the recipient has agreed to receiving a prayer quilt. I understand I am responsible for delivering the quilt.
*
Signed
Required
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