Good Samaritan

Contact

Please inform us of a member that is not in church today.
Name

Tel No.

Email

If you know the reason(s) they are not in church, please tick appropriate:
Out of town
Pressures of work
Sick
In hospital
Unemployed
Bereaved
Discouraged
Don't know
Other reason(s)

If we need to contact you about this person, please fill in your details
Your Name

Your Tel No.

Your Email