House Blessing Request

IMMACULATE CONCEPTION CATHOLIC CHURCH

91-1298 Renton Rd. Ewa Beach, HI 96706

Ph#: (808) 681-3701 | Fax#: (808) 681-3117

Fr. Siegfred Dosdos

***Please give 2-3 weeks notice for requested date.

I am/We are registered parishioners of Immaculate Conception Church in Ewa.

Yes

No

Not sure

Name of person requesting for House Blessing

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Alternate phone

Additional notes

Please share a preferred date and time. Your selection is NOT guaranteed unless you receive a confirmation from the Parish Office. If Fr. Sieg is unavailable, the Parish Office may propose another date and time.

Preferred date and time

Month

Day

Year

Time

HoursMinutes

Reason for House Blessing:

New home/just moved in

Extension/Additions to existing home

Other reason. Please explain:

Father or Deacon will contact you to confirm the date of the House Blessing. A house blessing will NOT take place unless those who live in it are:

Practicing Catholics
Members of Immaculate Conception Parish
In good standing with the Catholic Church

By submitting this form you agree and acknowledge the terms and conditions of requesting for a House Blessing and confirm all information provided is correct. Please double check your contact information and address.

Signature

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House Blessing Form

House Blessing Request