Prayer Request Form

Information about the person submitting the request. Fields marked by an asterisk* are required.

Name*

First Last

Address*

Street Address

City State Zip Code

Phone*

- -

### ### ####

Email*

Information about the person or persons concerned.

Name of the Person to be Prayed For*

Relationship to the Requestor (Example: Self, Spouse, Co-worker, Family Member, Neighbor, Friend, etc.)

Is this person

Member of KUMC

Non-member who attends regularly

Other

Specifics of the Prayer Request*

Check this box if you would like this request to remain confidential

(Please Note: Non-confidential requests are added to the prayer bookmark published in the weekly service bulletin.)

Check this box if you would like someone from our congregational care team to contact you.