Are You Sick or Quarantined? Question Title * 1. First and last name (if submitting for another person, please put both of your names.) Question Title * 2. Email Question Title * 3. Mobile Phone (or home phone) Question Title * 4. I am: Staying home because I am particularly vulnerable to illness Self-quarantining because I've been exposed to an ill person Self-quarantining because I have symptoms of illness Diagnosed with COVID-19 (Coronavirus) Caring for another person who is ill Question Title * 5. May we share your name with the congregation in prayer concerns? Yes No Question Title * 6. If you are receiving in-patient care at a hospital, or are staying somewhere other than your home, please tell us your location: Question Title * 7. Is there anything else you would like us to know? Done