Our Lady of Mercy Catholic Church

Homebound Parishioners

If you or someone you love is homebound, please complete the following form. Once completed, click on submit. This information will be kept confidential. Once we receive the information, you will be contacted by Theresa Foster from the Parish Office.

*Today's Date

*First Name

*Last Name

*Address

*City

*State

*Zip Code

*Phone Number

*Age

* Illness/Prognosis

I wish to receive the Eucharist

Yes

I wish to receive Reconciliation

Yes

*Nearest Relative/Contact Name (First & Last)

*Nearest Relative/Contact Phone

*Nearest Relative/Contact Address

*Nearest Relative/Contact City/State

*Nearest Relative/Contact Zip Code

*Relationship

*Email Address of Sender

* Indicates required fields

445 Marquette Ave.

Baton Rouge, LA 70806

225.926.1883

fax 923.0448