First and Last Name of the person to pray for:

Name

He/She is a:

Parishioner
Non-Parishioner

He/She is:

Sick
Deceased
Other (please specify below)

Please specify or elaborate on the prayer request:

He/She is my (brother, aunt, friend, etc.):

Your First and Last Name:

Name

Your Phone Number:

Phone Number

I am a:

Parishioner
Non-Parishioner