Service Form
Please fill out this form and click the Submit button at the bottom of the page.
My General Info:
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Communication:
I would appreciate a (choose one or more)
Please select all that apply.
personal phone call
personal email
scheduled personal visit
hand-written note
Zoom chat
Other (please describe)
Counseling:
I would like (choose one or more)
Please select all that apply.
to schedule a counseling consultation
resources dealing with (ex. PTSD, parenting, etc.--please list below)
Resources needed:
Other (please describe)
Community:
I am interested in (choose one or more)
Please select all that apply.
being part of a home group
being part of a Zoom small group
being part of an in-person small group
Other (please describe)
I am interested in (choose one or more)
Please select all that apply.
hosting a home group
hosting a Zoom small group
hosting an in-person small group
Other (please describe)
Compassion/Care:
(choose one or more)
Please select all that apply.
I would like to receive food
I need some small errands done
I am in need of temporary financial assistance
I am in need of help with technology
I am in need of help with obtaining and setting up a device to help me join online worship services
Other (please describe)
(choose one or more)
Please select all that apply.
I would like to participate in serving food to the homeless camp
I would like to prepare and deliver Love Food
I would like to run errands or make small repairs for those unable to do so themselves
I would like to help others with their computer technology problems
I would like to help serve when needs arise
Other (please describe)
Submit
Description
Please fill out this form and click the Submit button at the bottom of the page.
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