Care Request Form

Basic Information (these questions will help us)

Do you agree? *

This form will be seen by the Pastoral Care staff at City Church Rockford in order to properly assess your care request. By filling out this form, you are giving all Pastoral Care staff members permission to view this information.

Yes

No

Do you attend City Church Rockford? *

Yes

No

How often do you attend? *

Gender *

Male

Female

Marital Status *

Single

Married

Divorced

Widow/Widower

Birthdate *

Phone number *

Address *

Your Situation

How can we care for you? Please share a little about what you are currently walking through.

The Role of Spiritual Care

Spiritual care is provided by City Church Rockford for the expressed purpose of providing biblical help for those who seek it. We believe Jesus came to bring healing to the way we think, behave, and feel. He declared: "I came to bring healing to the brokenhearted, preach deliverance to the captives, and recover the sight to the blind, to set at liberty them that are bruised." (Luke 4:18)

Thank you for completing this form. One of our team members will contact you soon. God bless!