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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You're Invited: Worship Night

You're Invited: Worship Night

6101 NW 2nd Ave
Miami, FL33127

3100 NW 5th Ave
Miami, FL33127

You're Invited: Worship Night

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