Sick and/or Shut-In
Please use this form to submit the names of any Mt. Vernon members and associates to be added to the Sick list or the Shut-In list. Please use the comments line to add any details that you think would be useful. We will need a valid address and phone number in order to follow-up and/or possibly set up a visit. Thank you and have a blessed day.
Name of Sick or Shut-In Person*
This person is a member of Mt. Vernon Missionary Baptist Church.
This person is:*
 Sick (temporary)
 Sick (chronic, long-term illness)
 Surgery (is having or has had)
 Shut-In (can't come to church services)
Complete Address (if they'd like a sermon, visit or a card) Mailing Address City, State, Zip
Contact person's name & phone number: (include the area code)*
Request submitted by:
Comments: Please use this box to give any details that might be helpful when reaching out to this person.
A copy of this form will be submitted to the Pastor and/or his staff, as well as, the Mt. Vernon Women's Ministry who will embrace and pray for our Sick and Shut-In members, family and friends. Have a blessed day!