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Clergy Contact Visiting Application

What is your name?
First Name
Middle
Last Name
What is your date of birth?*
Are you female or male? *
What is your address? *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
What is your primary phone number?
What is another phone number where you can be reached?
What is your email address?
Name of Church/Congregation*
What is the address?
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
What is the phone number?
Provide the following information for a person in leadership within the church, congregation or organization you are currently serving and to whom you are accountable. Do not put your own name.
What is the person's name? *
First Name
Middle
Last Name
What is their address? *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
What is their phone number?*
What is their email address?
Are you currently part of a Worship Team with TJM? If so, which one?*
In applying for the Transforming Jail Ministries 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. *
First Name
Middle
Last Name
Date of application.*
*
By submitting this Clergy Contact Visiting application, you give Transforming Jail Ministries permission to send you information about TJM and the Clergy Contact Visiting program. We will not give or sell your information to others.

Transforming Jail Ministries ~ P.O. Box 198070, Cincinnati, Ohio 45219 ~ Phone: 513.794.9999 ~ contact@tjmi.org