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Please complete the appropiate section for hospitalizations or bereavements in order for our ministry to better assist you. If you need to contact The Worship Center's Administrative Office, please call 205-451-1750 or send faxes to 205-451-1759.

Sickness & Illness

Hospitalization

First Name

Last Name

Contact Person

Contact Number

Email Address

Connection to The Worship Center Member Professional Visitor Non-member

Hospital Name

Room #

Reason for Hospitalization

Date Admitted to Hospital

Expected Release Date

Follow up Requirements

Prayer Team

Calls

Visit

Has the Patient Requested this Visit

Yes

No

Deaths

Bereavement

First Name

Last Name

Address

Daytime Phone Number

Evening Phone Number

E-mail

Name of Decease

Connection to TWC Member Professional Visitor Non-member

Date of Funeral

Your Relationship to the Deceased

Please select any area(s) you would like us to minister to you in:

Grief Counseling

Prayer Request

Salvation

Other

If you selected Prayer Request or Other, please explain:

© The Worship Center Christian Church 2010. All Rights Reserved.
Administrative Offices: 9553 Parkway East, Birmingham, AL 35215 | p. 205.451.1750 | f. 205.451.1759 | www.theworshipcentercc.org