Communion & Homebound Ministry | The Living Word

Your Full Name

Your Email Address

This address will receive a confirmation email

Requester Phone Number

Who is this Communion & Homebound Ministry request for?

Myself My spouse My parent Another family member A friend Someone I care for Other

Full Name of the Person Receiving the Visit | If this request is for you, you may leave this blank. If you are requesting a visit for someone else, please enter their full name.

What type of ministry visit are you requesting? Select all that apply.

Holy Communion Prayer Scripture reading and encouragement Pastoral / spiritual support Homebound ministry visit Other

What is the primary reason you or your loved one are currently unable to attend worship services? Homebound due to health or mobility limitations Recovering from an illness, procedure, or hospitalization Living in a nursing home, assisted living, or care facility Temporary physical limitation Transportation or accessibility limitations Other circumstances Prefer not to say

Address for the Communion / Homebound Visit: Street Address • City • State • ZIP Code | Please provide the address where the ministry visit will take place. If this is a nursing home, assisted living community, hospital, or other care facility, please provide the facility name in the next field.

Facility Name, Room or Unit Number | If the visit will take place at a hospital, nursing home, assisted living community, rehabilitation center, or other care facility, please provide the facility name and room or unit number, if known.

Are there any special instructions our ministry team should know before arriving? Please include any helpful arrival information, such as gate or entry instructions, front desk check-in requirements, parking information, or the name of the person our ministry team should ask for upon arrival.

What day(s) generally work best for a ministry visit? Select all that apply. | Selecting a preferred day does not confirm an appointment. A member of our ministry team will contact you to coordinate and confirm the visit. Monday Tuesday Wednesday Thursday Friday Saturday Sunday My schedule is flexible

What time of day generally works best for a ministry visit? Select all that apply. | Your preferred time does not confirm an appointment. A member of our ministry team will contact you to coordinate and confirm the visit.

Morning Afternoon Evening My schedule is flexible

If this request is for someone other than yourself, are they aware of and agreeable to receiving a visit from The Living Word?

Yes — They are aware of and agreeable to the visit. No — I have not spoken with them yet. I am submitting this request for myself.

Is there anything else you would like our ministry team to know before the visit? You may share any prayer needs, spiritual concerns, accessibility needs, or other information that would help us prepare to serve you or your loved one. Please do not include detailed medical or other highly sensitive information.

Description

We Would Be Honored to Serve You or Your Loved One

At The Living Word, we believe those who are unable to attend worship should still have opportunities for prayer, encouragement, fellowship, and Holy Communion.

If you or someone you care for is homebound or otherwise unable to attend service, please complete the form below to request a ministry visit. Our team will contact you to discuss the request and make appropriate arrangements.

Communion & Homebound Ministry | The Living Word

Description

Please Fix the Following