Sick List Request

Please complete this form to add you or your loved one on the Prayer List.
Their name will remain on list for 4 weeks.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Name of person to pray for *

First

Last

Did the individual give permission to be added to the list? *

Yes No

Is this individual a parishioner at SJP2? *

Yes No

If the above answer is no, where? *

Illness or sickness *

Is this person in the hospital? *

Yes No

If yes, where? *

Is this person in a nursing home? *

Yes No

If yes, where? *

Submit