Program Notification Form

Program Notification Form

Upcoming Program details for the attention of the Kairos Support Office.
When this form is submitted, the Kairos Support Office (KSO) will:

1. EZRA: Order your Ezra software.
2. PRAYER VIGIL: Create your Prayer Vigil.
3. AGAPE: Update the international Agape website.
4. EXCELLENCE: Send the Excellence Initiative (EI) report to your leader.
5. LEADER: Advise Leader of various helps and passwords.

Any questions? Contact the KSO:

Email: operations@kairos.org.au or call 0498 012 263

Items marked with a * are mandatory and must be completed.
Program*

Kairos InsideKairos Outside
Region Name*
Program/Weekend Number*
Year*
Program start date and finish date
Prison Name - KI*
Kairos Inside
Weekend Venue Name and Address - KO*
Kairos Outside
State*
Select from dropdown
Regional Committee Chair's Name*

First NameLast Name
RC Chair's Email (Kairos Email only)*
example@kairos.org.au - confirmation will be sent to this email.
RC Chair's Mobile
Please enter a valid phone number.
Leader's Name*

First NameLast Name
Leader's Email (Kairos Email)
example@kairos.org.au
Leader's Mobile
Please enter a valid phone number.
Date Leader Ratified by State Council*

DayMonthYear
Date
Prayer Vigil Start Time

Hour Minutes

AM/PM Option
Prayer Vigil End Time

Hour Minutes

AM/PM Option
Other Core Leaders and Roles - if known
List names and their roles here if known at this stage.
Form Completed by:*

First NameLast Name
Should be Empty: