Prayer Request

PRAYER REQUEST

This form is for submitting a prayer request to the Mary, Mother of God Prayer Line. Your request will be kept in our prayer list for 4 weeks. All requests are kept confidential.
Contact Information:
This is the contact information of the person making this prayer request.
Requestor's Name (optional)

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Source (Check all that Apply)

Website SubmissionVerbal/Email RequestPrayer Request in Candle RoomRequest from Priest or Office1000 Hail Mary'sMemorial Mass SocietyBulletin Sick ListPriest/Deacon/Seminarian/ReligiousMilitaryOther
Your Prayer Request:
Please include the intention and any important names or dates. You may also include contact info - phone, address... (300 character max).
Who this intention is for: (optional)
Short Description of Prayer Request:*
Additional Details:
Additional Details (Optional):

0/600
Intentions will be added to the prayer list on the Start Date and kept on the prayer list for 4 weeks, if your needs are different, you may request alternate Start and Stop Dates.
Your Stop Date cannot be before your Start Date.
Please adjust your Stop Date.
Start Date
Stop Date
Please verify that you are human*
- Requestor
- Prayer Request Date
  
  YearMonthDay
  Default is Today
- Default Stop
  
  YearMonthDay
  Default is 4 Weeks
- StartNum
- StopNum
- DefStopValue
- From
- Should be Empty:

PRAYER REQUEST