St. John Vianney
Perpetual Adoration Chapel Request

Scheduling/Information Request Form

Yes, I am willing to spend one hour once a week with Jesus, who is truly present in the Blessed Sacrament.

Yes, I want more information about spending one hour once a week with Jesus, who is truly present I the Blessed Sacrament.


First Name:

Last Name:

Address:

City:    Zip Code: 

Phone:

Alternate Phone::

E-mail:

What day(s) and time(s) are you available? 

     Day:      Time:  

     Day:      Time:  

If you desire more than one hour, indicate on the next line the day and time:

Yes, I am willing to be on a "call list" to substitute during the following days/hours. I understand I am not required to "substitute" every time I am called. 

Thank you for your interest. Someone will contact you soon.

 

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