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Team Application

Apply to serve on the Kairos 56 team. Fill out the form below and you'll be taken straight to the official application to review and sign electronically — no printing needed. Fields marked with * are required.

Prefer paper? Download the blank PDF to print, sign, and return by hand.

Personal Information

First Name (on Driver's License)

Last Name (on Driver's License)

First Name for Name Tag

Date of Birth

Gender Role

Contact InformationHome Address

City

State

Zip

Cell Phone

Home Phone Driver's License # & State

Church Information

Church Name

Denomination

Church Telephone

Pastor's Name

Pastor's Approval

Spiritual Background

Attended Emmaus / Cursillo / similar weekend?

Year Attended

Participate in a Reunion Group?

Attended a Qualifying Weekend?

Kairos Experience

I have never served on a Kairos Team

Date Trained (if served before)

Dept of Corrections Trained?

Background Information

Are you an Ex-Offender?

Year Released

DOC #

Currently on Parole?

On a visitation list for an inmate at this prison?

If yes, Name

Relationship

Agreement

If accepted to serve on this Team, I agree to attend the Team Formation meetings, to participate in the continuing ministry of Kairos, to abide by the rules and policies of Kairos and the prison, and to support in good faith the activities and spirit of Kairos.

I certify that the information provided on this Application is complete and true to the best of my knowledge.

I have read and agree with the Mission Statement, Vision Statement, CORE Values, and Statement of Faith of Kairos Prison Ministry International, Inc.

I will obtain a current Kairos Inside manual, read it, and follow the program with no unauthorized additions or deletions.

Kairos Prison Ministry — WTSP Chapter

A Community spiritually freed from the effects of imprisonment.