Ministry to the Sick Forms

SECRETARIAT FOR LAITY, FAMILY, AND LIFE
Ministry to the Sick and Homebound

APPLICATION FORM
Name*

First NameMiddle InitialLast NameSuffix
Home Address*

Street Address

Street Address Line 2

CityState

ZIP
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Occupation
Phone Number (Cell)
Format: (000) 000-0000.
Phone Number (Home)
Please enter a valid phone number.Format: (000) 000-0000.
Parish*
City*
Deanery*
Are you registered in the parish?*
Have you completed the Safe Environment Training?*
Date Verified - Safe Environment

MonthDayYear
Date
Have you been Fingerprinted through the Diocese?*
Date Verified - Finger Print

MonthDayYear
Date
Ministers to the Sick provide a pastoral presence and the Most Holy Eucharist to our sick and homebound parishioners. Requirements for this ministry are: Fully initiated Catholics, active members of a parish. Sufficient age, maturity and temperament to undertake this ministry. Have no impediment to receiving Holy Communion and participate in the Sacramental life of the Church. Physically able to exercise this ministry. Have a current mandate as an Extraordinary Minister of Holy Communion (EMHC) from the Bishop of Orlando. Fingerprinted and Safe Environment Trained and Verified. Recommended and approved by Pastor Be willing to go through the certification process for Ministers to the Sick through the Office of Pastoral Ministry If driving for ministry purposes, be a verified driver in compliance with diocesan Driver’s License Verification Policy and Procedure
Have you been trained and mandated as an Extraordinary Minister of Holy Communion?*
Date of EMHC Training

MonthDayYear
Date
Do you hold a current mandate for the parish in which you are serving?*
Location of EMHC Training
Why do you want to become a Minister to the Sick?*
When are you able to do ministry visits?*

WeeklyBi-WeeklyMonthly
Which day of the week are you available to serve?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Ministry to the Sick requires continuing education and spiritual growth. Your certification must be renewed every five years by attending 15 hours of continuing formation. Hours can be completed by attending Diocesan Mornings of Reflection, Diocesan seminars or conferences, or parish-based seminars, series, etc. Hours must be kept track of through the Continuing Formation Form available through the Office of Pastoral Ministry.
Are you willing to commit to this Ministry for at least five years?*

YesNo
Are you willing to complete the requirements for certification, including continuing formation hours?*

YesNo
Scheduled Diocesan Training Session you will be attending
Have you been fingerprinted and completed Safe Environment training for the Diocese of Orlando?*

YESNo
Date Fingerprinted*

MonthDayYear
Date
Adult Driver Information
This form is for drivers age 21 and older. Drivers between the ages of 21 to 24 may only transport themselves when driving on behalf of the Diocese of Orlando. Drivers must be 25 years of age or older to transport passengers
Drivers License Number*
Drivers License Expiration Date*

MonthDayYear
Date
Vehicle That Will Be Used
Name of Vehicle Owner*

First NameLast Name
Address of Owner*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Model of Vehicle*
Make of Vehicle*
Year of Vehicle*
Drivers Plate Number*
Registration Expiration Date*
Insurance Information
When using a privately owned vehicle, the insurance coverage is the limit of the insurance policy covering that specific vehicle. Please note: The minimal, acceptable liability limit for privately-owned vehicles is $100,000/$300,000. The vehicle owner’s insurance is primary and the Diocese of Orlando does not provide insurance for the vehicle owner.

Insurance Company Policy # Date of Policy Expiration Liability Limits of Policy
Insurance Company*
Policy Number*
Date of Policy Expiration*

MonthDayYear
Date
Liability Limits of Policy*
Certification
I certify that the information given on this form is true and correct to the best of my knowledge. I possess a valid Florida driver’s license, have the proper and current license and vehicle registration, and have the required insurance coverage in effect on any vehicle that is driven or trailer that is towed to the location. I further understand that I must be at least 25 years of age if I will be driving a vehicle with passengers.

I grant the Diocese/parish permission to obtain a current driving record from the Florida Department of Highway Safety and Motor Vehicles to confirm that I have an excellent driving record. I understand it is my responsibility to update the Adult Driver Information Sheet if there are any changes to my driving information.
Please Initial in reference to the above certification*
I have completed the above diocesan Adult Driver Information and the Drivers License MVR Request Approval Form*

Yes
Signature*
Date*

MonthDayYear
Date
Should be Empty:

SECRETARIAT FOR LAITY, FAMILY, AND LIFE

Ministry to the Sick and Homebound

Adult Driver Information

Vehicle That Will Be Used

Insurance Information

Certification