Rockhampton Pastoral Care Form

Pastoral Care & Prayer Requests

Your Contact Details

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address

More Information

Do you attend Awakening Rockhampton?

If 'No', where do you attend church?

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

If you're filling out this form for someone else, please state their details below.

First Name

Last Name

Date of Birth

Phone Number

Do they attend Awakening Rockhampton?

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? *

I would like to be contacted by the Pastoral Care team. *

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.