Restoration Church - COVID19 HELP

First Name

Last Name

Email

Phone Number

Address 1

Address 2

City

State

Zip

County

How Many People Are Quarantined With You

If you live in a community with controlled access (gated community, senior living community, apartment complex, etc.), please provide instructions to help our delivery team reach your home. (Note: Due to COVID-19 concerns, some communities may not currently allow outside deliveries. Before submitting this form, please check to be sure that deliveries are allowed in your community.)

How Can We Pray For You?

Would you like to be contacted by Healing Hands ministry throughout your quarantine?
Yes
No

Would you like to receive meals from the church?
Yes
No

Would you be willing to be contacted by our Pastoral Council for your Spiritual support.
Yes
No

Our Healing Hands ministry will contact you to receive basic information. You can OPT out of continual communication at anytime.

COVID19 Support Request