Christ Lutheran Church - Dallastown, PA

Request for Pastoral Care / Visit

 

To arrange visitation, request a meeting, or receive a telephone call from Pastor Lawrence Cunnings, please complete and submit the following form. All requests submitted via this form are sent exclusively and directly to Pastor Cunnings personal e-mail, and are always treated as high-priority with strict confidentiality.

 

Your Name:

   *REQUIRED

FIRST                                 LAST

Your E-Mail:

 *REQUIRED

(ex. yourname@serviceprovider.com)

 
Contact Phone: () - *REQUIRED

Membership
Status:

Member of CLC congregation     Recent / Frequent visitor to CLC
Relative of a member                Friend of a member
Care Requested:

*REQUIRED

Preferences:

Please provide the preferred date and time...

DATE: ,     TIME:

  Location:

For visitations ONLY, please provide the preferred location...

TYPE:          

ADDRESS:   

CITY:            ,       ZIP:

 

Description:

Though it is not required, you are encouraged to share with us

as much detail regarding your specific needs as you wish...