Care Card Entry

CC Care Needs Form

We are here to help! Please complete the form below and one our staff members will be in contact soon.

Which Campus do you usually attend?

First Name

Last Name

Mobile Phone Number

How can we help? (select all that apply)

Interested in Baptism Visitation (hospital/facility/home) Death of a Loved One Counseling Referral Counseling Referral and Assistance (only available for CC Members) Speak to a Care Pastor or Associate Wedding / Premarital Counseling Financial assistance (Only CC Members; Must provide 3 months of bank statements; Must Provide local government issued ID) Other (please include details below)

Any additional details and helpful information can be added here:

If you are completing this card on behalf of someone else, please complete the below with your personal contact information should we need to contact you with questions.
We will only contact you if needed to best serve the requested person's care needs.
Thank you!

First Name

Last Name

Phone Number

Home Address

(Required for any financial assistance)

Care Team Requests are monitored and will be responded to within 24 hours.
If this is an immediate pastoral need please text or call the Emergency Line at 904.906.2273 (CARE).
If you need the authorities or have an urgent medical need call 911.

Submit Card Needs Form

Care Card Entry

CC Care Needs Form

We are here to help! Please complete the form below and one our staff members will be in contact soon.

If you are completing this card on behalf of someone else, please complete the below with your personal contact information should we need to contact you with questions. We will only contact you if needed to best serve the requested person's care needs. Thank you!

If you are completing this card on behalf of someone else, please complete the below with your personal contact information should we need to contact you with questions.
We will only contact you if needed to best serve the requested person's care needs.
Thank you!