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Redeemer JC Mercy Team Intake Form (Confidential)
Thank you for filling out this form for the Redeemer JC Mercy Team! This form will be confidential, meaning that the request will only be shared to mercy team members, who will follow up with you about your request. You can also reach out to the Mercy Team directly by emailing mercy@redeemerj.com. 
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Email *
Applicant's name *
Preferred method of contact *
Phone Number
Email
What are the obstacles that you are facing? 
How would you like the Mercy Team to help you to overcome these obstacles? 
What resources do you have access to or have used in the past? (social services, family, community organizations etc.) 
Do you have any additional thoughts, comments or notes for the mercy team?
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