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Adult Jail Chaplaincy Team Report Form

What is your name? *
First Name
Middle
Last Name
What is the month you are reporting for? *
What year is this report for? *
What are the total hours spent in jail chaplaincy ministry this month?*
Please list the names (last name first, please) of the prisoners you visited this month and that date of your visit/contact.
Did you respond for a specific crisis situation (e.g. Death notification, grief intervention etc.)
How has God used you in this ministry?
What is your email address?*
What is your name?*