RC CARES - HOSPITAL VISIT - Rust City Church

Phone number *

Address

Would you like a call/text from a pastor? *

Yes

No

Do you attend Rust City Church? *

Check all that apply

I Attend

Family Member Attended

Neither

HOSPITAL INFO

Name of the person in the hospital? *

Please select stage of life. *

Senior (60+)

Adult (20-59)

Teenager (13-19)

Child (2-12)

Infant (0-1)

Please Provide hospital name/address. *

Please provide any additional information that would be helpful for us to know.