Prayer Request and Pastoral Care Form

Person Making the Prayer Request


My connection to The Basilica:

Information for the Person(s) in Need of Prayer


Field Is Required The person in need of prayer is my: (Select one of the available choices or enter a different value.)
(Maximum response 255 chars, approx. 5 rows of text)
Field Is Required What is this person's connection to The Basilica?

What is this person's prayer need?

Illness
Requests Visit?
(Maximum response 255 chars, approx. 5 rows of text)
Deceased
Date of death:
Are there other bereaved family members that belong to The Basilica?
(Maximum response 255 chars, approx. 5 rows of text)
(Maximum response 255 chars, approx. 5 rows of text)
(Maximum response 255 chars, approx. 5 rows of text)

How shall we pray for this person?


The person making this request asks that we pray for this person through:
(Maximum response 255 chars, approx. 5 rows of text)
Field Is Required Do you have the individual's permission to mention his/her name publicly?
(Maximum response 255 chars, approx. 5 rows of text)
   Please leave this field empty