Kairos Forms for the Kairos Volunteer Management System · Nov 2014 Version 9 PSDG feedback KO...

Kairos Forms and KPMA Database.doc 2015 JANUARY Page 1 of 12

January 2015

Kairos Forms for the

Kairos Volunteer Management System

DOCUMENT VERSION Version 1 Initial Document Jan 2014

Version 2 Queensland feedback at Database training session Minor updates for contact details and address format

Notes on Clergy / Chaplains Qualifications (page 30)

Include revised script for KOW manual (page 9)

23 Feb 2014

Version 3 Feedback received from Kairos Program Support & Development Group (PSDG)

19 Mar 2014

Version 4

Inclusion of clearance checks for working with children. (page 14)

Incorporate a note on KO follow up (page 9)

Further update on KO follow up (page 9)

Page 20 amendments & lighter colours for monochrome

24 Mar 2014 3 Apr 2014 10 Apr 2014

Version 5

Presented to KPMA board meeting

Incorporate Form numbers

Revise Privacy policy wording

12 Apr 2014 22 Apr 2014

Version 6

Revision of Torch forms and process

Include Kairos Contact Application (page 31)

Team POSITIONS dropdown menu added (page 5)

Include Return Address for Forms

29 Apr 2014 4 Jun 2014 4 Jun 2014

Version 7

PSDG Feedback, Adelaide & Canberra training feedback & general improvements Feedback received via KSO FORMS:

KO-2002-1412: Replace KOW guest application with revised Expression of Interest Form

KGEN-4002-0406 & KT-3004-1404 & KI-1003-1404: Remove reference to website for online giving

KGEN-4003-1412 Combine KT-3004-1404 & KI-1003-1404 Application to attend closing

KI-1001-1412, KO-2001-1404, KT-3001-1412 – minor changes NOTES

Section 5 – Update notes on general forms

Page 10: Update KOW script to match new forms

Page 3: Add reference to Procedure document to have a volunteer’s details made available to other regions

Page 3: Updated Guidelines on the management of forms and information

20 Oct 2014 31 Oct 2014

Version 8 P22 - Incorporate Guest Special Needs form [KO-2005-1412] Final refinements

Nov 2014

Version 9 PSDG feedback KO 2001-1412 revised & removed ‘Area where you would like to serve’

KO-2002-1412 revised EOI

KO-2003-1412 revised & note to be completed with KO-2005-1412

KO-2004-1412 revised & removed special gifts & talents

KO-2005-1412 revised & guest to sight and sign pre-completed form

KO, KI, KT AGREEMENT & PRIVACY POLICY consent options numbered NOTES:

Page 2 – incorporate the use of forms in Kairos training

Page 10 – revised KO scripts NOTE: only KO forms were updated & PDF’ed . KI and KT forms remain unchanged

Dec 2014

Version 10 KPMA Board approval 12 Dec 2014

FINAL – all forms now dated 1501 Jan 2015


KPMA FORMS REGISTER Please note that forms should not be modified. If the form is not suitable or needs to be changed, please provide detailed constructive comments to the Kairos Support Office: [email protected] Forms can be downloaded from the Kairos Website under the member’s area (log in required) http://kairos.org.au/community-members-welcome-page/ http://kairos.org.au/community-members-welcome-page/volunteer-application-forms/ Form numbering denotes: Ministry e.g. KI / KO / KT / GENERAL Form number: KI range 1001-1003, KO range 2001 – 2005, KT range 3001-3004, GEN 4001-4003 Version / Date: 1501 is 2015 January (date of form is not included in the documents but on the actual form) (# denotes signed forms ## recorded & stored in Database)

Form Number Description Date Issued Page KGEN-4001-1501 ## Clergy/Chaplain Expression of Interest Jan 2015

KGEN-4002-1501 ## Kairos Contact Information and Agreement Jan 2015

KGEN-4003-1501 ## Application to Attend a Kairos Closing Jan 2015

General notes on the use of Forms Leaders should complete the Kairos Information on the forms prior to distributing the forms.

Each region will have their own unique requirements for the information they collect. A process on how the forms are used and information provided for the database should be determined by each region. This should meet the KPMA requirements.

The use of forms should be incorporated into the Kairos training program. This will enable the team members to better understand what and how information is used.

During team training, the leader should work through the form with the team member completing the form. This provides an opportunity to clarify and discuss any ambiguities.

mailto:[email protected]://kairos.org.au/community-members-welcome-page/http://kairos.org.au/community-members-welcome-page/volunteer-application-forms/


ThankQ DataBase: The Kairos Volunteer Management System Overview To aid the collection and responsible use of information collected through the various arms of Kairos (Kairos Outside, Kairos Inside, and Torch) a review was done on all the Kairos forms used to capture team and participants information. This document:

SECTION 1: Provides guidelines on how to manage forms and the information responsibly

SECTION 2: Lists the particular form in relation to where the information is recorded in the database

SECTION 3: 3.1 Kairos Outside Forms – overview 3.2 Kairos Inside Forms – overview 3.3 Kairos Torch Forms – overview

SECTION 4: 4.1 Kairos Outside Forms – the actual forms 4.2 Kairos Inside Forms – the actual forms 4.3 Kairos Torch Forms– the actual forms

SECTION 5: 5. General Kairos Forms 5.1 Kairos Clergy / Chaplains application form 5.2 Contact Information and Agreement 5.3 Application to attend Kairos Closing

SECTION 1

1.1 Guidelines on the management of forms and information

Contact the Leader / Committee for the information. Not all the required information is on one form. Some information like team positions, talks etc are part of the records the Leader creates.

It is best to go through the form explaining it while it is being completed. Discuss any uncertainties. Check with regional committee as to procedures and information needed.

Pre-populate the Kairos (orange boxes) information before handing out the form for others to complete

Most of the Team information is recorded on the “Team Member Information” form.

Most of the participant / guest information is recorded in the “Privacy Policy & Database information” form. Note that these forms include a signature as agreement to have the information recorded in the database. These forms are scanned and stored in the Database.

Treat information confidentially and respect the contact and personal information that you have been intrusted to.

Store forms in a safe and secure place (don’t leave it lying around for others to see. Don’t lose it)

Enter or revise the information as soon as possible in the database. The sooner the better.

Destroy the forms responsibly once the information has been entered and you have checked that it is correct. Inform the Committee when this is done and the process complete.

In cases where a person is active in more than one region; a request can be made to Kairos Support Office to make arrangements for the person’s details to be available to the other region/s by proving them access to this persons records in the database. For cross-regional visibility to be set up, both/all the regions have to agree that that the data can be shared. This procedure only relates to team members and not guests/participants. Refer to the: ‘Procedure to enable contact information to be shared across regions’

Comply to the KPMA Privacy Policy: Kairos Prison Ministry Australia will comply with the requirements of the Privacy Laws. The information provided by you will be held in a secure database under the control of Kairos Prison Ministry Australia (KPMA). This information will be used for the primary purpose of informing you of programs organised by KPMA and associated administrative functions. It will also be used to inform you of activities, events and general information about KPMA. Except as required by law, your information will not be disclosed to any other person or organisation. Further information is available on the Kairos Website (http://kairos.org.au/privacy-policy/) or by contacting the Kairos Support Office (02 9987 2016) and requesting a copy of the Privacy policy

http://kairos.org.au/privacy-policy/


SECTION 1

1.2 Procedure

1. Contact Leader / Regional committee to collect information & forms

2. Record relevant information in the database

3. Scan signed documents and load into the database

4. Check for changes, accuracies and duplicates

5. Destroy relevant forms

6. Inform committee that the process is complete

SECTION 2

Forms in relation to the Kairos Volunteer Management System – the Database NOTE: Refer to the Training Manual – Editing and Adding Contacts, to learn how to create and edit

information in the Kairos Volunteer Management System. Information recorded in the Kairos Forms but NOT in the Database Kairos Form Kairos KPMA DataBase

Application to attend – KO

Application to attend - KI/KT Closing

Name & Surname of the person in prison – related to person doing KO Weekend

NOT RECORDED KO Weekend use only MIN number of person in prison -

related to person doing KO Weekend

House / Wing of person in prison - related to person doing KO Weekend

Relationship to the person in prison - related to person doing KO Weekend

Application to attend – KO Emergency Contact NOT RECORDED KO Weekend use only Medicare Number

Private Health Provider

Team Member Information – KI / KO / Torch

Application to attend – KI / KO / Torch

Special dietary needs NOT RECORDED Course / Weekend use only

Medical needs NOT RECORDED Course / Weekend use only

Team Member Information – KI / Torch


Driver’s license / Passport number NOT RECORDED Course / Weekend use only

Information recorded in the Kairos Forms – recorded indirectly in the Database Kairos Form Kairos KPMA DataBase



Database Info & Privacy policy - KO

Chaplains Expression of Interest

Language other than English Volunteer – Details, and /or Contact – Profile Contact – Communication Tab, attachment Contact – Communication Tab, attachment; User defined tab for privacy detail Contact – Communication Tab, attachment; User defined tab for Chaplain’s detail

Application to attend – KO



How did you find out about Kairos

Volunteer – Details, Contact – Profile Contact – Primary Category: Closing Ceremony - Communication Tab, attachment

Who referred you to Kairos Contact – Communication Tab, attachment; User defined tab for privacy detail

Application to attend – KI / Torch NOTE: depends on the Region / Institution – mostly NOT recorded in the Database

MIN number of person attending Kairos Inside Short Course

Contact – Primary Category – Inmates – MIN under profile

Name & Surname of the person in prison – Person attending Kairos Inside Short Course

Contact – Primary Category – Inmates

Team Member Information – KI / Torch

EZRA

Clearance Forms from the Institution / Corrective Services

Clearance Form Date VOLUNTEER module


SECTION 2

Forms in relation to the Database VOLUNTEER: Primary contact information for each individual. Linked to three Main components: SKILL, POSITIONS, JOBS KPMA DataBase Description Kairos Source / Kairos Form Kairos Form: Reference Start Date Date Volunteer became

involved with Kairos. Participants: Weekend / Course

Date Team: first time on team / involved

Volunteer Source Where the Volunteer originated from. E.G. Emmaus / Cursillo / Guest


Application to attend KI/KT Closing


Personal Information

Volunteer Manager

Surname / Organisation

Surname of person / volunteer



Application to attend – KI/KT Closing


Surname

Title MR / MRS / MS / MISS / REV / DR

Title

First Name Formal / Legal Name Name (full)

Initials / Other Name Preferred Name Name (preferred)

Post Nominal Tel (day) Contact telephone number

during the day Team Member Information – KI / KO / Torch

Application to attend - KO / Torch

Application to attend – KI/KT Closing Chaplains Expression of Interest

Telephone (day)

Tel (eve) Contact telephone number during the evening

Telephone (evening)

Mobile Mobile Number Mobile @-mail Personal email address EMail

Fax Fax NOT RECORDED

Date of Birth Date of Birth Team Member Information – KI / KO / Torch




Date of Birth

Care of Person associated with the Volunteer. E.G. secondary contact person

NOT RECORDED

Address 1 Primary contact address No & Street





Address 2 Suburb State WA / SA / NSW / ACT / VIC

/ QLD / NT

Post Code Post Code Country Country – Default is

Australia

Contact Position

Website Website associated with the Volunteer

NOT RECORDED

Envelope Salutation Name displayed on the envelope

Letter Salutation Persons name in the letter

Address Type Residential / Business NOT RECORDED

Address Code 3 Contact Type Individual (single person /

volunteer) Linked to CONTACT

Primary Category Contact – region / community the Volunteer is associated with

Linked to CONTACT

Ensure Volunteer is ticked – if primary category is a REGION (not an Organisation)

Occupation Work the person does Team Member Information – KI / KO / Torch


Occupation

Gender Male / Female

Previous Names Previous Name NOT RECORDED Marital Status Married / Single NOT RECORDED

Preferred method Email / Post Default is Email Picture File

Default Address Preferred Address to use for mail

If mail – ensure that E-mail = YES and CC E-mail OK = YES

Default is Email


SECTION 2

Forms in relation to the Database SKILLS: Qualification - what they are capable of are set up here. Includes Special Skills / Gifts / Talents of the volunteer KPMA DataBase Description Kairos Source / Kairos Form Kairos Form: Field Reference Skill E.G.

Accounting, Chaplain, Culinary, IT, Innovative, Musician, Secretarial, Public Speaking EKI, EKO, EKT, EZRA



Database Info & Privacy policy – KO

Need some qualification

Special Gifts and Talents recorded in Team Application & Privacy Policy – Database Information

Approval required Professional positions that need approval E.G. Head Chaplain / Ordained Minister / EKI / EKO for leaders

POSITIONS: Kairos Team Positions held by the volunteer Can append a SKILL to a POSITION

KPMA DataBase Description Kairos Source / Kairos Form

Position Team Position E.G. Leader, Table Leader, Server, Agape

Leader Documentation Kairos Manuals EZRA Need some qualification

NOTE: talks & meditations are recorded under DETAILS of the Volunteer Module NAME: Talk / Meditation VALUE: Talk Title

Description Description of the role E.G. Media and IT – coordinate music and talk presentations.

Approval Required E.G. Head Chaplain / Ordained Minister E.G Clearance to enter institution E.G. Working with Children check E.G Leader of Weekend / course

KI Positions KOW Positions KOM Positions TORCH Positions KI-Agape & Prayer KI-Chapel Coordinator KI-Clergy / Chaplain KI-Clergy / Chaplain Leader KI-Inside Coordinator KI-Inside Coordinator Assistant KI-IT & Media KI-Kitchen / Dining KI-Kitchen / Dining Coordinator

KI-Leader KI-Leader Advising KI-Leader Observing KI-Music KI-Music Leader KI-Servant KI-Servant Head KI-Table Family Assistant KI-Table Family Leader

KOW-Agape KOW-Agape Coordinator KOW-Angel KOW-Angel Coordinator KOW-Chaplain KOW-Chaplain Head KOW-IT & Media KOW-Kitchen / Dining KOW-Kitchen / Dining Coordinator

KOW-Leader KOW-Leader Advising KOW-Leader Observing 1 KOW-Leader Observing 2 KOW-Music KOW-Music Coordinator KOW-Prayer KOW-Prayer Coordinator KOW-Server KOW-Server Head KOW-Table Leader KOW-Table Leader Head KOW-Talk Facilitator

KOM-Agape Coordinator KOM-IT & Media KOM-Kitchen / Dining KOM-Kitchen / Dining Coordinator

KOM-Leader KOM-Leader Advising KOM-Leader Observing KOM-Music KOM-Music Leader KOM-Supplies Coordinator KOM-Table Family Assistant KOM-Table Family Clergy KOM-Table Family Leader

KT-Agape KT-Agape Leader KT-IT & Media KT-Kitchen / Dining KT-Kitchen / Dining Leader KT-Leader KT-Leader Advising KT-Leader Observing KT-Lite’n Lively KT-Lite’n Lively Leader KT-Mask Meditations KT-Music KT-Music Leader KT-Prayer KT-Spiritual / Clergy KT-Spiritual / Clergy Leader KT-Table Family Leader KT-Table Family Servant

JOBS: What you want to do - E.G. run a short course / weekend / event Each JOB has POSITIONS assigned. Can allocate a JOB to a Volunteer

KPMA DataBase Description Kairos Source / Kairos Form DATA to enter

Description Kairos Course / Weekend / Event

Leader Documentation Kairos Manuals EZRA

Course Name # Weekend Name #

Volunteer Name Name of the person serving on team (same for all team positions)

Position Position on team Connected to POSITIONS Leader and other team positions

Client Kairos Community E.G. Kairos Prison Ministry / Regional Committee / Institution

Regional committee responsible for the event

End Date Date the Course / Weekend / Event finishes and the job is finished

Leader Documentation

Date of event

Volunteer Volunteer number from volunteer list Database / Kairos VMS Team member


SECTION 2

Forms in relation to the Database CONTACT: Kairos Supporter, Business, Trust or any other entity that is of value to KPMA. Kairos Region, Committee, Institution or Community to which the Kairos Volunteers related to. Each Volunteer is connected to a CONTACT. The CONTACT is the core component: Other VOLUNTEER information is linked to the CONTACTS. CONTACT: Other relevant fields to note: KPMA DataBase KPMA Database

TAB under CONTACTS Kairos Source / Kairos Form

Do not Mail MAILING PREFERENCES Team Member Information – KI / KO



Checklist – KO Guest application

Do not Publish

Do not Call

Use Address From Use Address Until

ADDRESSES Application to attend – KO

Team Member Information – KI / KO / Torch Address Changed & Date Changed

ADDRESSES

Email OK ADDRESSES

CC Email OK ADDRESSES

Church Denomination Church Name

PROFILE Team Member Information – KI / KO / Torch

Partner PROFILE

Team Assignments Weekend / Course #

PROFILE Leaders Documentation

EZRA

Group / Region Name Committee Type

GROUPS GROUP TYPE MANAGER SERIAL NO: Volunteer

Can attach minutes and documents Type: Regional committee, working group Volunteer: Chairperson / Coordinator

CONTACT: Kairos Supporter, Business, Trust or any other entity that is of value to KPMA. Kairos Region, Committee, Institution or Community to which the Kairos Volunteer is related to. Each Volunteer is connected to a CONTACT. The CONTACT is the core component: Other VOLUNTEER information is linked to the CONTACTS. CONTACT: Other relevant fields to note: KPMA DataBase KPMA Database

TAB under CONTACTS Kairos Source / Kairos Form

Do not Mail MAILING PREFERENCES Team Member Information – KI / KO



Checklist – KO Guest application

Do not Publish

Do not Call

Use Address From Use Address Until

ADDRESSES Application to attend – KO

Team Member Information – KI / KO / Torch Address Changed & Date Changed

ADDRESSES

Email OK ADDRESSES

CC Email OK ADDRESSES

Church Denomination Church Name

PROFILE Team Member Information – KI / KO / Torch

Partner PROFILE

Team Assignments Weekend / Course #

PROFILE Leaders Documentation

EZRA

Group / Region Name Committee Type

GROUPS


SECTION 5

General Kairos Forms (used across all arms of Kairos)

KGEN-4001 Clergy/Chaplain’s Expression of Interest This form is designed to capture information relating to persons who are interested in becoming involved with Kairos through being clergy or chaplains on teams. It is only required for potential clergy/chaplains and should not be completed by persons who have previously filled such positions on team. The following extracts are from the respective Manuals: Kairos Outside for Women Manual Page 60:

KOW – head chaplain needs to be ordained (or denominational equivalent)

Certified by an approved theological college and endorsed by the Regional Committee

Other Chaplains can be: Roman Catholic Nun / hold a formal position that requires theological training / be licensed/certified and active in pastoral counselling / have at least one year of full time theological training with a focus on pastoral care of counselling and current relevant experience.

Kairos Inside – Red Manual – KPMA 9/12 II-25 to II-28 Persons who serve as clergy on Kairos teams should meet the following qualifications: 1. a. Have received formal training by their respective denominations and be officially ordained or

licensed, or b. Be recognised as ministers of good standing, having approved theological training and being

actively engaged in, or retired from, full or part-time involvement in Christian ministry, and 2. Be able to work effectively in an ecumenical environment, and 3. Personally accept and affirm the Kairos Statement of Faith (viz. the Nicene Creed.) The Kairos Short Course Manual provides more detail in Section II

KGEN-4002 Contact Information & Agreement The purpose of the Contact Information & Agreement is to capture general information of any person who may be interested in Kairos Prison Ministry Australia, whether that is as a potential guest, team member, and general volunteer or to receive further information. If a person has completed an insert to a brochure then that can be either attached to the form or the information transferred to it. The form can be used to assist with entry of the information into the KPMA Database as well as the tracking of what has happened since the enquiry was received. The Contact Information & Agreement Form can be handed out at any Kairos event or promotional opportunity to enable interested people to be contacted. The signature is to ensure that the person is aware of the recording of their information on the KPMA database. Note that where a person completes an insert to a brochure then this could be taken as their giving approval for their details, as provided, to be recorded within the KPMA Database.

KGEN-4003 Application to attend Kairos Closing Complete the relevant sections of this form to collect the contact and other information required to get approval for a person to attend a Kairos closing held in an institution.


SECTION 5

General Kairos Forms (used across all arms of Kairos)


[KGEN-4001-1501] KAIROS:

CLERGY / CHAPLAIN’S EXPRESSION OF INTEREST (page1/1) This form is usually completed before the team selection process starts

Some of this information is recorded in the database

Please return the completed application to your local Kairos Regional Committee

Kairos Regional Committee Chair Person:

Contact Details:

Kairos Website http://kairos.org.au

Contact Information FIRST NAME

PREFERRED NAME

SURNAME MR / MRS / MS / MISS / REV / DR

DATE OF BIRTH GENDER (Male / Female)

STREET ADDRESS

SUBURB

POST CODE

POSTAL ADDRESS

SUBURB POST CODE

Is this your permanent Address

YES NO I am at this Address Until

DATE: STATE

EMAIL (preferred)

EMAIL (secondary)

MOBILE

TELEPHONE (day)

( ) TELEPHONE (evening)

( )

Best Time / Place to call

Language other than English

Qualifications

What formal training do you have

Theological College Attended

Ordination Date (If applicable)

What pastoral care position do you hold

How long have you held this position

Referee Name

Relationship

Referee Contact Number

Referee eMail

Personal Information (Recorded in the database - for team selection purposes) Add an additional page if you wish to provide more information

I ATTENDED: Please indicate & list if you were a Guest / Team / Observer

Kairos Inside

Kairos Outside Preparation for Kairos (PFK)

Kairos Torch Emmaus Cursillo Other

Most recent date attended

Church Name Church Denomination

Please list your special gifts & talents

Why do you want to be on a Kairos team

As a member of a Kairos team you will need to: 1. Obtain a current Kairos Australian Manual and become familiar with your responsibilities 2. Undertake to attend team formation, the Kairos weekend / course and the reunions that follow. 3. Agree to support, in good faith, the Kairos activities, as well as the theological and scriptural content of the talks as outlined in the

Kairos Australian Manual 4. Abide by the rules of confidentiality

Print Name Signature Date:

NOTE: if emailing a digital form, please type in your name in both the ‘Print Name’ and ‘Signature’ boxes.

PLEASE NOTE: Specific qualifications are required to be a Chaplain / Clergy on a Kairos team. This form will be used to assess clergy positions.

http://kairos.org.au/


[KGEN-4002-1501] KAIROS GENERAL:

CONTACT INFORMATION & AGREEMENT (page1/1) This form is completed by a person who would like to find out more about Kairos OR who would like to support the Kairos Ministry.

This information is recorded in the database

Please complete this form if:

You are interested in receiving more information about Kairos and Interested to be placed on our database so we can contact you

Please Note: The purpose of this form is to record relevant details to assist Kairos in the general management of Kairos, overall analysis of Kairos Prison Ministry in Australia and keeping you informed of Kairos initiatives (if you select to be informed). At no time will personal details be passed on to anyone else other than those directly involved in the administration of Kairos. More information regarding Kairos is available on our website - http://kairos.org.au Kairos Information (Completed by the Committee Chairperson OR Kairos Support Office before distributing this form)

Kairos Region / Community Name

Kairos Support Office (KSO) Contact Name

Regional Chair Person / KSO Contact Details

Kairos Follow-up

Person contacted YES NO

Details updated in the KPMA database

YES NO

Notes

Contact Information (recorded in the KPMA database)

FIRST NAME

MR / MRS / MS / MISS / REV / DR

SURNAME DATE OF BIRTH

STREET ADDRESS

SUBURB

POST CODE

POSTAL ADDRESS

SUBURB POST CODE

EMAIL

MOBILE

TELEPHONE (day)


( )

Interest in Kairos


Who referred you

1. Would you like to be contacted to learn more about Kairos? YES NO

2. Would you like to receive Kairos Newsletters or general information from Kairos Prison Ministry Australia YES NO

3. Be informed of requests to pray for the Kairos community? YES NO

KPMA Privacy Policy: Kairos Prison Ministry Australia will comply with the requirements of the Privacy Laws. The information provided by you will be held in a secure database under the control of Kairos Prison Ministry Australia (KPMA). This information will be used for the primary purpose of informing you of programs organised by KPMA and associated administrative functions. It will also be used to inform you of activities, events and general information about KPMA. Except as required by law, your information will not be disclosed to any other person or organisation. Further information is available on the Kairos Website (http://kairos.org.au/privacy-policy/) or by contacting the Kairos Support Office (02 9987 2016) and requesting a copy of the Privacy policy.



http://kairos.org.au/http://kairos.org.au/privacy-policy/


[KGEN-4003-1501] KAIROS GENERAL:

APPLICATION TO ATTEND A KAIROS CLOSING (page 1/1) This form is completed with the relevant security documentation required for the specific institution, and then returned for processing.

Names of those who attend the Kairos Closing Ceremony are recorded in the Kairos Prison Ministry (KPMA) secure database

About Kairos Kairos Prison Ministry Australia (KPMA) is a community based ministry that serves both those in prison and their family and friends on the outside. More information regarding Kairos is available on our website - http://kairos.org.au

If you would like to attend a Kairos Closing Ceremony, please:

Complete this form and the relevant Correctional Services documentation required

Send the completed forms to the address below by the due date shown

Provide Driver’s license upon entry or relevant security identification as required by the particular institution

Kairos Information (to be completed by the leader prior to distributing the forms)

Kairos Course Name & number

Kairos Contact Name

Institution Address

Kairos Contact Details

Closing Ceremony Date

Forms in by date

Closing Ceremony Start time

Instructions to meet: place / time

Kairos Website http://kairos.org.au

Kairos Regional Committee Postal Address

Kairos Regional Committee Contact Details

Contact Information (recorded in the KPMA database)

FIRST NAME (as on your photo ID)

MR / MRS / MS / MISS / REV / DR

SURNAME DATE OF BIRTH

STREET ADDRESS

SUBURB

POST CODE

POSTAL ADDRESS

SUBURB POST CODE

EMAIL

MOBILE

TELEPHONE (day)


( )

Interest in Kairos (recorded in the KPMA database)

I ATTENDED: Please indicate & list if you were a Guest / Team / Observer

Kairos Inside

Kairos Outside Preparation for Kairos (PFK)

Kairos Torch Emmaus Cursillo NO: Have not attended any

Most recent date attended


Who referred you

Are you already involved in Kairos? YES NO

Would you like to receive Kairos Newsletters or general information from Kairos Prison Ministry Australia? YES NO

Are you interested to be on a Kairos team? YES NO

Security checks (NOT recorded in the KPMA Database) Complete if relevant for the institution OR discuss this with the Kairos Leader

Are you on a visitation list for any inmates in prison?

YES NO Name of person

(optional) Relationship to you.

(optional)

At which correctional facility?

Your Driver’s license / Passport No

I will read the enclosed security guidelines for visitors and agree to abide by them YES NO

KPMA Privacy Policy: Kairos Prison Ministry Australia will comply with the requirements of the Privacy Laws. The information provided by you will be held in a secure database under the control of Kairos Prison Ministry Australia (KPMA). This information will be used for the primary purpose of informing you of programs organised by KPMA and associated administrative functions. It will also be used to inform you of activities, events and general information about KPMA. Except as required by law, your information will not be disclosed to any other person or organisation. Further information is available on the Kairos Website (http://kairos.org.au/privacy-policy/) or by contacting the Kairos Support Office (02 9987 2016) and requesting a copy of the Privacy policy.


http://kairos.org.au/http://kairos.org.au/http://kairos.org.au/privacy-policy/

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