VOLUNTEERS AND MENTORS

Please print out, fill out and mail or fax to our address:

Safe Harbor Mentoring Program

20 Reith Street

Copaiague, NY 11704

tel. 631-789-2688 ext. 244

fax. 631-789-4156

Volunteer Participation Form

[ ]     Prayer Partner

[ ]     Pen Pal

[ ]     Music Ministry ( Please check one  ___Vocal   Instrument __________)

[ ]     Corporate Sponsor

[ ]     Mentor

[ ]     Financial Support

[ ]     Ministerial Support

[ ]     Human Resource Instructor

[ ]     Other ____________________________________________________

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Church or Organization Name:  _____________________________________

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Name and Title:  

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Address: ______________________________________________________

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Phone Contact:

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