EmailMeForm
Helping Hands Request Form
Hello! Please read the information below and fill out this form in its entirety so we can best help you. Someone will reach out to you shortly.
Please read about the 5 services we offer on our website before completing this form.
Please be aware this is not a benevolence request form, please do not use this form to request financial assistance. Please visit the church office in person to request financial assistance. Benevolence request can NOT be made online or over the phone.
Thank you!
Your Name
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First
Last
Your Email
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Confirm Email
Best Phone Number to reach you
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Address
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Street Address
City
State / Province / Region
Postal / Zip Code
Birthdate
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MM
/
DD
/
YYYY
How long have you attended CBC?
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Tell us a little about you:
What type of service are you requesting? (choose one)
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Errands
Chores
Transportation
Visitation
Meals
Please explain in depth your current situation and how we can best help you:
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If you are requesting meals how many people are in your household and do you have any dietary or allergy restrictions?
Have you received assistance from the Helping Hands Ministry before? If so when and what for?
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Additional comments