Mi Sheberach Healing Prayers Form

If you would like the community to keep you or a loved one in mind this Shabbat, and include you/them in their thoughts and prayers, please fill out the form below. This form will be read by one or more members of the Spiritual Leadership team, who will offer their prayers. Names of Kehilla members will be read aloud during the Mi Sheberach for healing during Shabbat morning services.  Names will be kept on the Mi Sheberach list for one month, unless you indicate otherwise.

If you have trouble with the Mi Sheberach form below, please contact Maristella at maristella@kehillasynagogue.org or (510) 547-2424 ext.100 with your wishes for the Mi Sheberach List.

Your Name *
Your Email *
Your phone number
For whom would you like prayers directed?
This can be yourself or someone else.
 *
If you are filling this out on behalf of someone else, please describe your relationship to them. 

Please only complete this form if you have this person's consent, or, if they are unable to give consent, please do your best to discern whether they would welcome this prayer and give their consent if they were able.
Their Hebrew Name (if known):
This can be yourself or someone else.
Are they a Kehilla member?
This can be yourself or someone else.
 *
Required
Add name to Mi Sheberach list on this date
Enter a date (if appropriate) of surgery, travel, visit, event, etc. If left blank, we will add to the list right away.
MM
/
DD
/
YYYY
Remove from this list on this date.
If left blank, we will remove from the list one month after it's added. 
MM
/
DD
/
YYYY
In need of prayer due to: 
If you wish, enter the reason why the community should hold this person in their thoughts. A healing from disease, a surgery, recovery from illness, grief, a long journey....
 *
Please check all that apply regarding future communication: *
Required
If you are filling the form out on behalf of another Kehilla member, and you've indicated above that they would like to be contacted, please provide their contact info below. 

If not you can skip the questions below. 
Email address of member you are filling out form for:
Phone number of member you are filling out form for:

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This form was created inside of Kehilla Community Synagogue and School.