COVID-19 – Ford Street Church

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COVID-19 Assistance Request

Ford Street Church wants to help. If you have a need for assistance during the COVID-19 "coronavirus" pandemic, you may submit that need using this form. For prayer requests, we invite you to utilize our Prayer Wall.

1Consent

2Contact Info

3Request for Assistance

Consent is required to begin*
Your submission will be emailed out to representatives of Ford Street United Methodist Church. Your responses may contain sensitive information and we will do our best to maintain confidentiality, but it is not something we can guarantee.
We also cannot guarantee a rapid response. Church representatives will do their best to respond in a timely manner. Your request is likely not being sent to a healthcare professional and cannot provide medical assistance. For emergency needs, please call 911.
I give my consent.

Name*
First Last
Phone*
Email
Address
Street Address Address Line 2 City State ZIP Code

What is your concern today?*
- Grocery assistance
- Loneliness or depression
- Financial crisis
- Pastoral care needed
- Other need explained below
Details
Please tell us a little more about your issues and concerns.
Are you experiencing symptoms of COVID-19?*
Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases. Symptoms of fever, cough, and shortness of breath may appear 2-14 days after exposure. (Source: CDC)
- Yes
- Maybe - I'm not sure
- No
Are you a member of Ford Street Church?*
This helps us stay informed about our church family. You do not have to be a member of our church to receive assistance, although we do hope you'll visit again someday.
- Yes
- No
- Related/friends with a member of Ford Street Church
- Former member or attending another church
Phone
This field is for validation purposes and should be left unchanged.

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