STMBC Prayer Request Form
Submit a prayer request for St. Thomas MBC JAX
Submitter Information
Full Name
*
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Member / Non-member Status
*
Please Select
Yes, I am a member
No, I am a visitor
I attend regularly but am not a member
Preferred Contact Method
Email
Phone
Text Message
No follow-up needed
Prayer Recipient
Name of person to be prayed for
Relationship to you
*
Please Select
Self
Spouse
Child
Parent
Family Member
Friend
Coworker
Other
Prayer Request Details
Prayer Request
*
Urgency Level
Urgent
Soon
Ongoing
Privacy & Sharing Preferences
Confidentiality Preference
*
Share with pastoral staff only
Share with prayer team only
May be shared with congregation
Permission for Follow-Up
Yes, you may contact me about this request
Submit Prayer Request
Should be Empty: