GIPPSLAND Prayer & Pastoral Care Request Form • Fire Church Ministries Inc.

GIPPSLAND Prayer & Pastoral Care Request Form

Please fill out this form if you have any prayer requests or pastoral care needs:

Your Contact Details

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address

More Information

Do you attend Fire Church?

YES

NO

If 'YES', which campus do you attend?

Gippsland

Other

If 'No', where do you attend church?

How long have you been a born-again Christian for?

Who is the prayer or pastoral care request for?

Is the request for somebody else?

Yes

No, its for myself

First Name *

Last Name *

Date of Birth

Phone Number *

Email

Do they attend Fire Church?

If 'No', where do they attend church?

How long have they been a born-again Christian for?

How Can We Help?

What is your prayer request or reason to contact the pastoral care team? *

Would you like to be contacted by the Pastoral Care Team? *

YES

NO

Preferred Method of Contact *

Phone

Email

Thank you for filling our this form and reaching out for pastoral care and prayer. Please note that all your personal details and information will remain confidential and will only be seen by those entrusted to pray with you.