People Follow-Up

Person Filling Out Form

Person filling out form

Date*

I am a:

Life Group Leader
Living Free Life Group Leader
James River Church Staff

Your Name*

First Last

Your Email*

Your Phone Number*

Person Needing Care:

Person Needing Care

Name of Person*

First Last

Gender*

Male
Female

Email

Phone

What is their relationship/connection to JRC?*

Attends JRC
Does not attend JRC

How are they connected to JRC?*

Which campus do they attend?*

What is the circumstance of their need?*

Please ask them to go to the JRC webpage and click “Need Help” to request groceries. This communication will help the JRC team assisting with these needs!

Date of surgery*

Hospital Location*

Type of Surgery*

Date Hospitalized*

Hospital Location*

Circumstance of Hospitalization*

Date they will be released to go home

Please Explain*

Name of Deceased*

Relationship to Attendee*

What are the Funeral Arrangements?

Please Explain*

Date of Birth*

Gender*

Boy
Girl

Child's Name

Hospital*

Date mom and baby will be released to go home*

Update Status*

Update contact information
No longer attending James River Church

What would you like to update?*

Address
Phone
Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

What is the circumstance?*

Is this a Salvation or Rededication?*

Salvation
Rededication

Do they own a Bible?*

Yes
No

Date of decision?*

Please tell us the story!

Who tested positive and what is their relationship?

Please give us details*

Actions taken by Life Group/Staff

For example: Phone Call, Meal Taken, Visited, etc.

People tell us your story*

Additional notes/comments