Chabad of Rockland - Mi Shebeirach List
Reminder to remove from list once prayer is no longer necessary
Email address *
Please join us in prayer for those in need of recovery or for those in need of G-d's salvation.
Adding or Removing a name *
Your Name *
Name of person filling out this form
Phone Number *
Relation *
How are you related to the person who needs the blessing?
Tell us about the one needing a prayer
First & Last English Name *
Name of person in need of a prayer
Hebrew Name *
Hebrew Name (if known) of person in need of a prayer
Woman or Man? *
Bat = Daughter of / Ben = Son of
Mother's Hebrew Name *
Hebrew name (if known) of the Mother of the person who is in need of a prayer
What are we praying for? (not required)
Recovery from illness, Surgery, Medical Procedure, etc.
We wish a quick and complete recovery for all those in need! May you come by soon to tell us good news!
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of The Hebrew Academy. Report Abuse