Prayer Blanket Request Form

Prayer Blanket Request Form

Fill out all required fields, please.
Tell us about YOU

Thank you for requesting a Prayer Blanket for your loved one. Please tell us how we can contact you should we have any additional questions.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Tell us about who will be receiving the Prayer Blanket

We personalize each blanket and keep them in our prayers as we make each unique blanket. Help us succeed in creating something personal that will bring them comfort and healing.
Who is this Blanket FOR?*

First NameLast Name
What illness is the recipient facing?*
We will only ship blankets outside of the Acadiana area. Please make arrangements to pick up if it is going be within Acadiana parishes. Will the Blanket be picked up or shipped?*

Acadiana Pick up location: First Baptist Church, 1100 Lee Ave, Lafayette, LAPlease ship (Address required below-must be outside Acadiana area)
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Recipient is:*

Adult MaleAdult FemaleYouth MaleYouth Female
If for a child, what is their age:
Prayer Blanket Ministry

First Baptist Lafayette

1100 Lee Avenue

Lafayette LA 70501

Thank you and have a blessed day!
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