Board Members

Steve Berger

Elder/Financial Board

Mark Bright

Elder

James Brown

Elder

Kurt Beasley

Elder

Ron Clonts

Elder

Scott Farrar

Elder

Ron Gonser

Elder

Tyler Ring

Elder

Rick Wood

Elder

Steve Lee

Financial Board

Fred Nance

Financial Board

Steve Craver

Financial Board

Johnny Ring

Financial - In Perpetuity From Heaven

Reese Smith

Financial Board

Don White

Financial Board

2019 Host Family Application
Please include everyone who is currently living in your household
Family Member Name Relationship (Father, Mother, Child, Aunt, etc) Gender (M/F) Date of Birth Email (If 18 years or older) Phone (If 18 years or older)
How many guests can you accommodate?
We prefer to host:
- Male
- Female
We're interested in hosting:
- Students
- Chaperones
- Both students & chaperones
I understand that my application to be a host family with the Kids on Stage program requires me and any of my household members who are 18 or older to submit to a criminal background check. The background check will also include a motor vehicle records check for anyone in my household who might drive / transport the Kids on Stage students and teachers. A separate Background release form must be attached for each household member who is 18 years or older.
E-Signature*
First Last
By typing my name, I hereby certify this as my electronic signature.
Today's date*
Date Format: MM slash DD slash YYYY
Household Address*
Street Address Address Line 2 City State ZIP Code

Family Member Name	Relationship (Father, Mother, Child, Aunt, etc)	Gender (M/F)	Date of Birth	Email (If 18 years or older)	Phone (If 18 years or older)

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