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OLPH Ministry to the Sick Extraordinary Minister of Holy Communion Visit Report
Please fill this form out after you have made a visit or engaged in a ministry act for one of our parishioners who is sick or home-bound.
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Email
*
Your email
Volunteer First Name:
*
Your answer
Volunteer Last Name:
*
Your answer
Please click each facility that you visited. If homebound, please go to the next section. If facility is not listed, please write in the facility name in the next section.
Bellmont Village
Brookdale Dogwood Creek
Brookdale Germantown
Gardens of Germantown
Germantown Plantation
Harbor Chase of Germantown
Baptist Rehabilitation
Methodist Germantown Hospital
Village of Germantown
If you visited someone who is home-bound, please enter their full name below:
Your answer
Date of visit or activity:
*
MM
/
DD
/
YYYY
Please enter the number of people you visited at this location on this date:
*
Your answer
Special requests or comments:
Your answer
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