I would like to submit a prayer or special need request (or an update to a prior request) to NCS New Canaan. I understand that only the text in the "Prayer Request/Update" box below will be distributed to the NCS New Canaan Prayer Group (e.g., if I want members of the Prayer Group to be able to contact me, I must include my contact details in the prayer request box), and it will be distributed as typed (including any typos); however, NCS New Canaan reserves the right to edit the request/update in any manner they deem necessary or appropriate and the right not to distribute the request for any reason. NCS New Canaan may also include my initials and the nature of the prayer request on a prayer needs slide shown at meetings. I also understand that text in the "Special Need" box below may be distributed more broadly at the discretion of NCS New Canaan, together with my name and contact information, in order to try to find help. In any event, this form, in its entirety, may be distributed to the NCS New Canaan leadership team.

IMPORTANT REMINDER AND AGREEMENT: By submitting this form, I consent to the distribution of information in this form as described above. While members of the NCS New Canaan Prayer Group understand when they subscribe that prayer requests are confidential, I understand that none of the New Canaan Society, NCS New Canaan, any of their leaders or anyone else can guarantee confidentiality or accepts responsibility for any breach of confidentiality. By submitting a prayer request (or update), I agree not to include any information that could harm or embarrass any person if it were to be shared more broadly, not to include any information about someone else without their permission and not to try to hold any of those parties (or any other person) responsible or liable for any breach of confidentiality (and to hold them harmless if anyone else mentioned in, or impacted by, my request or update attempts to hold them responsible or liable). I also understand that special need requests will not be considered confidential and may be distributed as deemed appropriate by NCS New Canaan in a good faith effort to find assistance.