St. Patrick Church

First Name: *

Last Name: *

Address: *

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A confirmation will be e-mailed to this address.

Please select DAY preferred: *

Please select TIME BLOCK:

Specify HOUR preferred from selection above:

Please check the months you will commit to:

3mo

6mo

9mo

1 year

Are you interested?

Would you be interested in creating an adoration group, with friends or other parishioners, to help facilitate hours?

Date/Time:

Are you currently coming at a specific date or time, that you would like to keep in the future?

Questions/ Comments: