St. Mary

250 KRAFT Street Berea - OH - 44017-1449 phone - 440-243-3877

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Recipient Information

- Parish Life

The maximum number of form submissions has been reached. This form is currently not available.
- Parish Home Connection is a ministry promoting and providing parish life connections and companionship to those unable to do so independently.
- Date: REQUIRED Please fill out this field. Please enter valid data.
- Recipient's Name - Mr., Mrs., Miss: REQUIRED Please fill out this field. Please enter valid data.
- Birthdate: REQUIRED Please fill out this field. Please enter valid data.
- Parishioner: REQUIRED Please fill out this field.
- Email: Please enter valid data.
- Home Phone: Please enter valid data.
- Cell Phone: Please enter valid data.
- Address: REQUIRED Please fill out this field. Please enter valid data.
- Preference for first contact with ministry volunteer: REQUIRED Please fill out this field.
- Emergency Contact:
- Name: REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Contact relationship to recipient REQUIRED Please fill out this field. Please enter valid data.
- * For questions please contact [email protected] or the Parish Office at (440) 243-3877.
  
  Allow 2 weeks for a contact from a Parish Home Connection Volunteer.
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