On-Line Parish Contact Form

Parish Contact Form

The Office for Persons with Disabilities (OPD) goal is to have a Parish Contact/Advocate from each parish acting on behalf of persons with disabilities and their families in assisting pastors in their role of inviting people to full participation within the Parish. Contacts are volunteers who serve as liaisons between persons with disabilities and their parishes and between the parish and Archdiocesan Office for Persons with Disabilities.

Name of Parish *

Parish Name, Town

Parish email

example@example.com

Person appointed as Parish Contact: *

First Name Last Name

Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Parish Contact Phone Number

Area Code Phone Number

Parish Contact email

example@example.com

Pastor's Name

First Name Last Name

Date Parish Contact appointed by pastor

Date

Parish Contact is: *

Newly Appointed Continuing Service

Name of person completing this form

First Name Last Name

Email

example@example.com

Phone Number

Area Code Phone Number

Thank you very much for your assistance in completing this information.

Office for Persons with Disabilities & The Deaf Apostolate
222 North 17th Street
Philadelphia, PA 19103
www.opdarchphilly.org