Sick Notice

The following is to be used to gather information for publication in the weekly bulletin.

Date Submitted :

Time Submitted :

Information Given By :

Callers Phone :

Please complete this section. If information is unknown, verify with membership services before distribution.

Sick – Home Information

Name :

Address :

City :

State :

Zip :

Phone :

Member of New Faith Baptist :

YesNo

Deacon :

YesNo

Ministries Active In (Separate by Coma) :

Sick – Hospital Information

Name of Hospital :

Address :

City :

State :

Zip :

Phone :

Room :

Bed :

Type of Illness :

Additional information :