TEAM APPLICATION

(You must be at least eighteen years old. Please fill in all blanks)

 

A team formation period is required for each Kairos short course. Its primary purpose is to bring team members to love each other and to build a Christian community of Christ’s disciples. The team formation period is highly structured with a well-defined agenda. The team learns about the prison environment, rules of the prison and problems to be addressed. Specific tasks pertaining to the program are defined, explained and assigned during the team formation. KAIROS is continuing ministry. Team service also includes participating in KAIROS’ continuing ministry—such as monthly reunions at the prison.

 

If accepted to serve on a KAIROS team, I commit to attending the team formation meetings and participating in the monthly reunions at the prison (for inside team members only). Further, I agree that before serving on the Three-Day weekend, I will understand and:

     (1)…support in good faith the activities on the weekend as well as the theological and scriptural content of the talks as outline in the Kairos Manual.

     (2)…abide by the rules and procedures of the institution as a condition of entry into the prison.

 
 

 
 

 
 

 
 

 
 

   Prefix                            First name as shown on D/L                     Mid. Initial                           Last name as shown on D/L                                         Suffix          Lay/Clergy

 

 

                                                             

                                                                                              Home  address                                                                                                                                            Nickname

 

 

                                                        City                                                                             State                                     Zip

 

 

                                                           

                                                   Another address (PO Box, Church , Business  -  Not your home)

 

 

                                             City                                                                         State                                          Zip

 

 

      Day area                 Day number                                    Eve area                 Eve number                                         FAX                                                          E-mail

 

 

    Gender M/F            Date of birth                               Drivers license number            Social Security number                 TDCJ Trained?

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 
     (3)…abide by the rules of confidentiality as se forth in the Kairos Manual

 

 

 

 

 

 

1
 
 

 

 

 

 

 


          

2
 

 

PLEASE

FILL IN BLOCKS

1

AND

2

THEN

SIGN
 
                                                 I attended ___________________  No.___________  Date:________ Place: ___________________

                                                                                    (Emmaus, Cursillo, etc.)

                                                            Please list on the back of this form talks you have given on other 3-day weekends including KAIROS.

Are you actively participating in a Reunion Group in your 4th Day community?    ...Yes____         Are you  Are you related to or do you know any inmates in this Unit (other than Kairos …Yes____ No____

                                 Are you on the visitation list for any inmate in this Unit? …………………………..Yes____ No____

                                 If “Yes”, their name(s):___________________________ Number (if known)_________________

                                 Their relationship (son, friend, fiance, etc.) ________________________________

Your Church:__________________________________________   Denomination___________________________

Address:______________________________________________  City:__________________________________

Pastor’s Name:_________________________________________  Church Telephone:______________________

This application has my approval:

Pastor’s signature:______________________________________   Date: _____________________________
 
                                                     Your signature:_______________________________  Date:____________________   

 


 

Return To: Reb Bacchus

701 County Road 104

Georgetown, Texas 78626

(512) 863-4383

rebnet@verizon.com
 

Team Information

Unit: Bartlett State Jail

Bartlett, Texas

Team  No 2

From:   03/3/05   to   03/6/05

 

 

 
 
 

    Team

Registration

 
 
  Number