Request Care

Are you filling out this form for yourself or someone else?*

Filling out for myselfFilling out for someone else

What is your first and last name?*Your Phone Number*Please provide the best phone number to reach you.Which VOUS Church location do you attend?*Crew Leaders and/or Team LeadersIf applicable, please tell us the name(s) of your crew leader and/or team leader.

What is the name(s) of the VOUS member needing care?*Please tell us the individual's first and last name.What is your first and last name?*Their Phone Number*Please provide the best phone number to reach the individual in need of care.Which VOUS Church location do they attend?*Crew Leaders and/or Team LeadersIf applicable, please tell us the name(s) of this individual's crew leader and/or team leader.

Reason Requesting Care*Please identify the reason you are requesting care.

Please select the type of celebration*

MarriagePlease Provide:
- First & Last Name of the Couple
- Date of Marriage
- Couples Mailing Address

BirthPlease Provide:
- First & Last Name of the Parents
- Date of Birth
- Child's Gender
- Family's Mailing Address

New Foster / Adopted ChildPlease Provide:
- First & Last Name of the Parents
- Date of Adoption/Foster
- Child's Gender
- Childs Age
- Family's Mailing Address

Please select the type of medical need*

Recent SurgeryPlease Provide:
- Type of Surgery
- Back at home or still in the hospital?
- Would this individual like for us to send them a recovery meal or flowers?
- Home or Hospital Address (If the individual is still in the hospital, please include the room number.)

HospitalizationPlease Provide:
- The reason this individual is hospitalized
- Is this individual aware of this visitation request?
- Hospital Name & Room Number
- What are the hours of visitation?
- Are we allowed to bring flowers?

New Medical DiagnosisPlease Provide:
- Name of the diagnosis
- How can we support you or this individual?

Please select the type of bereavement*Please Provide:
- If other, please explain below
- Name of Deceased
- Relationship to the Deceased
- Spouse of the Deceased
- Please let us know how we can support you or this individual's family during this time.
- Would you like for us to send flowers? If so, please provide a name and best mailing address below.

Please select the type of disaster*Please Provide:
- If other, please explain below
- Details of the incident.
- How can we support you or this individual or family during this time?

Please select the type of family/marriage need*Please Provide:
- Explain the situation and how we can help.

What emotional symptoms have you or this individual been experiencing?*Please Provide:
- A brief explanation
- Are you or this individual ready to speak to someone?

Reason financial support is needed*Please Provide:
- If other, please explain below
- Please explain how we can help you or this individual

Thank you! Your submission has been received!
Please give our team 72 hours to respond.

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VOUS Worship

Christmas at VOUS

VOUS Worship

Christmas at VOUS

6101 NW 2nd Ave
Miami, FL33127

3100 NW 5th Ave
Miami, FL33127

VOUS Worship

Christmas at VOUS

VOUS Care Request

6101 NW 2nd AveMiami, FL33127

3100 NW 5th AveMiami, FL33127

6101 NW 2nd Ave
Miami, FL33127

3100 NW 5th Ave
Miami, FL33127