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Add a Name to the Sick List

- Whenever a member of our community is sick, we entrust them to the Lord and join them in prayer for their physical and spiritual healing. If you would like to add a name to our parish sick list, please fill out the form below.
  
  IMPORTANT: Filling out this form does NOT indicate you are requesting Anointing of the Sick or Last Rites. If you wish to arrange for a priest to administer the sacraments, please click here.
  
  Due to privacy, we can only accept sick list additions with permission from the ill person or a relative.
- who should we pray for?
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Sick Person's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Street Address REQUIRED Please fill out this field. 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.
  
  Is this person a parishioner? REQUIRED Yes No Please fill out this field.
  
  Is he/she in the hospital? If so, which one? Vassar Westchester Medical
  
  Other Please enter valid data.
  
  Has he/she (or family member) given permission to be added to the sick list? REQUIRED Yes No Please fill out this field.
  
  Please share anything you'd like us to know (i.e. kind of illness)
  
  Requester Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Relation to Sick REQUIRED Please fill out this field. Please enter valid data.
  
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