CARE LIST Registration Form

Phone Number:

E-mail address:

City:

Zip:

Name:

 Address:

State:

Name:

Relationship:

Phone Number:

Home Communion :

Church Member in need:

Family Member Contact:

E-mail address:

Assistance Requested (check all that apply):

CD’s of services mailed by the church secretary:

Sunday Bulletins:

Regular print Upper Room delivered by monthly visitor:

Large print Upper Room delivered by monthly visitor:

Transportation to church events (ex. fellowship supper):

The Nurture Ministry provides assistance to church members needing a little extra care.

Comments: