Prayer Request Form


Please fill out this short form and let us pray for you. If you would like your prayer kept private - just between you, the pastor and God, please remember to check NO for the Knee Benders list, otherwise all prayer requests will be added to our Knee Benders list. This prayer list is distributed and prayed over by our congregation.

Note: Only your name, the name of the person your praying for and your prayer request will be added to the Knee Benders list. All other information will be held in the utmost confidence and will never be given away or sold for any reason.



Useful Information

Would you like to be added to the Knee Benders list?
  Yes
Would you like to be added to our mailing list?
  Yes

Personal Information

*Name:
Address:
City:
State:
Zipcode:
*Email:

Prayer Information

This Prayer is for My:
The Name of the Person I'm Praying for is:
I would like to Pray for:
For multiple selections, hold the Ctrl button down...
*Message
Validation Code:     4CMLE
* Are required fields

Contact Information

Central Christian Church
1482 S. Major St
Salt Lake City, Utah 84115
Phone: 1(801) 363 5559