Diaconal Intake Form

If you are interested in receiving assistance from the Redeemer Deaconate (a group of lay leaders at Redeemer) please fill out the intake form below.  We have limited resources but are eager to love our neighbor as our selves.

Name *
Name
Address *
Address
Phone
Phone
What is the preferred way to contact you?
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DO NOT ENTER ANY CREDIT CARD NUMBERS HERE.
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Please list any of the following and $ amounts in savings account, IRA, 401K, Pension plan, annuity, etc. DO NOT ENTER ANY ACCOUNT NUMBERS HERE.