Application for Clergy Contact visiting privileges in the
Hamilton County, Ohio Corrections Facilities
First Name Middle Last
Social Security # - - Why is this necessary?
Date of Birth Choose monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Choose day12345678910111213141516171819202122232425262728293031 Choose year198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935
Street Address City State Zip
Primary Phone Home Cell Business
Secondary Phone Home Cell Business
E-mail
Name of Church/Congregation
Denomination
Primary Phone Secondary Phone
Church, Congregation, Organization website www.
Provide the following information for a person in leadership within the church / congregation you are currently serving and to whom you are accountable. Do not put your own name.
Name
Title/Position
In applying for the Transforming Jails Ministry Clergy Contact Visiting Program, I authorize the release of any records/information necessary to support/refute any item in this application for contact visiting. I further agree to release from all liability any person(s) or institution(s) supplying any of the information requested by the Sheriff of Hamilton County, Ohio or designated representatives.
Place full name here
Date of Application Choose monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Choose day12345678910111213141516171819202122232425262728293031 Choose year200920102011
