Pledge Form

Lake County Jail Ministry, Inc.

CHAPLAIN Kenneth Hall

12920 Painesville-Warren Road
Leroy, OH 44077


Ministry to the Incarcerated Serving men and women in the Lake County Jail with the life-changing Gospel of Jesus Christ.

Donor Information (please print or type)


Billing address

City, STATE Zip Code

Phone 1 | Phone 2

Fax | Email

Pledge Information

I (we) pledge a total of $____________________ to be paid: ☐now ☐monthly ☐quarterly ☐yearly.

I (we) plan to make this contribution in the form of: ☐cash ☐check

Gift will be matched by (company/family/foundation)

☐form enclosed☐form will be forwarded

Acknowledgement Information

Please use the following name(s) in all acknowledgements:


☐I (we) wish to have our gift remain anonymous.



Please make checks, corporate matches,

or other gifts payable to:

Lake Co. Jail Ministry Inc. 12920 Painesville-Warren Road
Leroy, OH 44077

{copy and paste this to save and fill out. Mail to the address provided above}

updated 11/2018 by KPM



Lake County Jail Ministry

Church or Group Volunteer

Application Form

Name ____________________________________________________________
Address ____________________________________________________________
Phone ____________________________________________________________
Email ____________________________________________________________
Pastor’s Name ____________________________________________________________
Pastor’s Phone ____________________________________________________________
Additional Contact ____________________________________________________________
GROUP INFORMATION Please fill out group affiliation with the church
Type of Group: 􀂆Bible Study 􀂆Prayer 􀂆Men’s 􀂆Women’s 􀂆Missions 􀂆Support

􀂆Other: ___________________________________

Name ____________________________________________________________
Address ____________________________________________________________
Group Leaders Name ____________________________________________________________
Group Leaders Address ____________________________________________________________
Group Leaders Phone ____________________________________________________________
Group Leader Address ____________________________________________________________
Additional Contact ____________________________________________________________


􀂉 Our church/group is praying for you 􀂆In-Jail Ministry
􀂉 Our church/group would like to have a speaker come to one of our meetings/services 􀂆Individual Mentoring

􀂆Ministry in Spanish

􀂉 Our church has space to host a support group 􀂆 After care
􀂉 Our church would like to facilitate a support group -Provide leadership 􀂉 Our church/group will host fundraiser

Type of Event: ________________________________

Date of Event: ________________________________

􀂉 Our church/group took a special offering for Lake County Jail Ministry 􀂆Other: _____________________________________________________


Please copy and paste this form to a printable document ap. Fill it out and mail to

“Chaplain Ken Hall/ c/o Lake Co Jail Ministry, Inc ,

12920 Painesville-Warren Rd.

Leroy, OH 44077″


Thank you !Updated by kpm 11/2018

Lake Co Jail Ministry

Like this:

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.