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Visitation Ministry Request Form

- ANY URGENT REQUEST FOR A PRIEST
  PLEASE CALL THE OLM RECTORY
  201-391-5315
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Fill out the form below to request a phone call from one of our volunteers.
  
  First Name of Person in Need of a Call REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name of Person in Need of a Call REQUIRED Please fill out this field. Please enter valid data.
  
  Address of Person in Need of a Call REQUIRED Please fill out this field. Please enter valid data.
  
  Address of Person in Need of a Call 2 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 Call REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Person Requesting the Phone Call REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number of Person Requesting the Phone Call REQUIRED Please fill out this field. Please enter a phone number.
  
  Email of Person Requesting the Phone Call REQUIRED Please fill out this field. Please enter an email address.
  
  Relationship to Person in Need of the Phone Call REQUIRED 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.
  
  Request REQUIRED Phone Call from Visitation Ministry Phone Call from a Priest Please fill out this field.
  
  Additional Information about the Parishioner in Need of a Call
  
  Submit
  
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Our Lady of Mercy

2 FREMONT AVENUE

PARK RIDGE, NJ 07656

Visitation Ministry Request Form