Free Cloth Face Mask Request Form
Welcome to the Murrysville Community Church face mask request form! Please use this form to request free cloth face masks for your family. Requests will be met on a first-come, first-served basis, but we hope to honor all requests as quickly as possible.

Masks are being distributed on Fridays from 4-6pm from the parking lot of Murrysville Community Church (3750 School Road, Murrysville, PA 15668). If you have any questions, please email We look forward to serving you!
Name (first and last) *
Email address (we will use this to let you know when your masks are ready) *
Zip code *
Number of ADULT face masks needed (please only 1 mask per adult)
Clear selection
Number of small CHILD face masks needed (ages 2 and older only and 1 mask per child). An adult mask may be a better option for older children.
Clear selection
Other comments
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