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Chesed Notification Form
Please verify reCaptcha before submitting the form.
Thank you for your help in identifying chesed needs in our community
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NAME OF THE PERSON FILLING OUT THE FORM
Phone Number
EMAIL
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NAME OF THE PERSON WHO IS IN NEED OF SOME CHESED (LOVING-KINDNESS)?
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DID YOU GET PERMISSION FROM YOUR FRIEND OR RELATIVE TO SHARE THIS INFORMATION? (IF NOT, PLEASE CHECK WITH YOUR FRIEND OR FAMILY BEFORE CONTINUING THIS FORM.)
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TELL US BRIEFLY ABOUT THE CIRCUMSTANCES OF YOUR FRIEND OR RELATIVE (ILLNESS, SURGERY, HOSPITALIZATION, INFERTILITY, ETC.)
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HOW WOULD YOUR FRIEND LIKE TO RECEIVE CHESED? (SELECT ALL THAT APPLY)
CALL OR VISIT FROM CLERGY
VISIT FROM THE CHESED GROUP (MADE UP OF CONGREGANTS)
NAME ADDED TO MI SHEBEIRACH LIST
NO RECOGNITION - THEY JUST WANT US TO KNOW
Mon, December 30 2024
29 Kislev 5785
Mon, December 30 2024 29 Kislev 5785