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Pastoral Care Ministry Request Form

- ANY URGENT REQUEST FOR A CLERGY
  PLEASE CALL THE OLM RECTORY
  201-391-5315
  
  A visit from one of
  the Priests, Deacons, Eucharistic Ministers,
  a friendly visit or phone call
  from The Visitation Ministry or
  an errand from The Good Samaritan Ministry
  is available for parishioners
  through The Pastoral Care Ministry.
  
  These ministries keep those at home or
  at a facility, who are faced with
  limitations due to illness,
  injury or other life events,
  connected to Our Lady of Mercy
  Church community.
  
  FILL OUT OUR REQUEST FORM
  or
  CALL THE RECTORY 201-391-5315
  or
  CONTACT DEACON ANDY ZUCARO [email protected]
- The maximum number of form submissions has been reached. This form is currently not available.
  
  When you fill out the form below, it can be used for any of the following ministries:
  A NON-URGENT VISIT FROM CLERGY
  EUCHARISTIC MINISTRY
  VISITATION MINISTRY
  THE GOOD SAMARITAN MINISTRY
  
  First Name of Person Needing a Pastoral Ministry Care Visit REQUIRED Maximum 100 characters Please fill out this field. Please enter valid data.
  
  Last Name of Person Needing a Pastoral Ministry Care Visit REQUIRED Please fill out this field. Please enter valid data.
  
  Address of Person Needing a Pastoral Ministry Care Visit REQUIRED Maximum 100 characters Please fill out this field. Please enter valid data.
  
  Address of Person in Need of a Visit Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number of Person in Need of a Visit REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Person Requesting the Visit REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number of Person Requesting the Visit REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email of Person Requesting the Visit REQUIRED Please fill out this field. Please enter an email address.
  
  Relationship to the Person in Need of a Homebound Visit REQUIRED Maximum 100 characters Please fill out this field. Please enter valid data.
  
  Have you notified the person to be called? REQUIRED Yes No Please fill out this field.
  
  Additional information that will help the clergy and ministers better serve you.
  
  Request(s) REQUIRED Receive a (NON-URGENT) Visit from a Priest Receive a (NON-URGENT) Visit from a Deacon Receive Holy Communion from a Eucharistic Minister Receive a Social/Prayerful visit from The Visitation Ministry Receive assistance from The Good Samaritan Ministry Please fill out this field.
  
  Submit
  
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