Care Team Referral

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Care Team Referral

The CityChurch Care Team is made up of ministry partners who are committed to providing comfort through a system of support for other church members going through crisis, adversity, or a major life event. If you or someone you know needs care, please fill out the information below.

Date Submitted *

YYYY

Time Submitted *

Time

Recipients Name *

- Last name, First Name

Recipients Mobile Phone Number

Recipients Email

Recipients Address

Is this care need for you? *

Yes, for me

No, but for someone in my household

No, someone in our church community

Other:

Required

If you are not the one needing the care please leave your contact info below:

please provide first and last name and contact information

Please tell us the type of care needed: *

Crisis- requiring immediate response such as hospitalization or death

Comforting - Not immediate. (For example, illness, birth, loss of loved one, financial struggle)

Continuous- Hands on help such as home repair, chores, cleaning in home, moving

Counseling /Prayer - Meeting with a pastoral or prayer ministry team member

Unsure

Other(celebrations, birthdays, anniversary)

Required

If other, tell us more. *

Feel free to briefly describe the situation (Optional)

How would you like a Care Team Member to contact you?

Thank you for taking time to fill out this questionnaire. We look forward to supporting you or your loved ones very soon.

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