Join “Our Safe Home” Directory – Safe Harbor Cohasset Coalition

We would like your permission to list your name as a member of a network of Cohasset families & businesses who took the pledge to participate in the Our Safe Home Directory, and other related publications. (Cohasset residents & businesses only)

Please complete form below to join!

Name *

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Last

Directory Listing Name *

Please specify how you would like your name/family/business listed i.e.: “Mr. John Smith”, ”The Smith Family”, etc.

Email *

For business listings only, please provide your website to be listed in the OSH Directory

Please Select One Option Only *

You May Publish: Name, Address, Email, Phone.
You May Publish: Name, Address & Email Only.
You May Publish: Name, Address & Phone Only.
You May Publish: Name & Address Only.
You May Publish:Name Only.

Address To Be Published

Phone Number To Be Published

OPTIONAL Do you have children? If so, please provide their name, grade, and school they attend.

Please Type Name to Provide Permission to Safe Harbor to Enroll You in the Our Safe Home Directory *

First

Last

This document is not a contract and no consideration has been given by any party or entity which has elected to sign this document. It is understood that any parent, guardian, family member, or any other party or entity, who voluntarily chooses to participate in Our Safe Home Directory program, does so in order to express a collective desire to provide a safe, substance-free environment for our community’s children, while simultaneously acknowledging that no program, effort, or treatment is ever able to guarantee any particular result or environment. This document does not create any duty of care or enforceable substantive or procedural rights of any type, and no individual, entity, or perceived beneficiary shall rely upon or interpret any portion of this document as establishing any rights or remedies of any type whatsoever.