Submit A Prayer Request

If you’d like to submit a prayer request please either fill out a prayer request card (located in the pews) on Sunday and drop it in the offering plate or by filling out the form below.
As always, communications are confidential and are seen only by our staff. The information with * is required in order to accept your request. This information allows us to properly follow up on requests submitted. We will always respect the privacy of your personal information and do not distribute, sell, or publish it. Thank you for allowing us the opportunity to bring your request before God.

First Name

Last Name

Street Address

Address Line #2

City

State

Is the person being prayed for a Christian?

Relationship to Pleasant Valley Baptist Church?

Do you want this information added to our announcements?

Would you like member of the church to visit you or the person you’re requesting paray for?

Hospital Information (if applicable)

Subject of Prayer Request (required)

Prayer Request (required)

Submitter’s Name

Submitter’s Phone Number (for any clarifications)

Submitter’s Email

Submit A Prayer Request

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