1. I state that I am seeking help at Sheepgate.
2. I am able to consent to my participation in this program in its entirety.
3. I have read the Sheepgate Student Guidelines and I agree to abide by them.
4. It is my intention to complete the 12-month minimum Sheepgate residential discipleship program.
5. I release to Sheepgate to right to search, read and withhold my mail in the manner explained in the Student Guidelines.
6. I release to Sheepgate the right to conduct a room search without warning.
7. I release to Sheepgate the right to make a thorough search of my person and belongings on the day of
admission.
8. I understand that withdrawal from drugs, alcohol, and nicotine will be accomplished “cold turkey” and with the assistance of staff.
9. I understand that Sheepgate will not be held responsible for any of my personal property that is lost or stolen while I am in the program. When leaving Sheepgate, I understand that all of my personal property must be taken with me or it will be disposed of after a 7-day waiting period. Any unclaimed funds remaining on a student account following departure from the program will be submitted to the state as unclaimed property.
10. I hereby release Sheepgate from all financial and legal responsibilities in case of accident, injury, illness or other misfortune.
11. Any items that are brought to Sheepgate that are listed under “Forbidden Items” in the Student Guidelines will be discarded or sent home at my personal expense.
12. I agree to submit to the authority of all staff members and interns.
13. I release to Sheepgate the right to speak freely with the persons listed below, as indicated by the corresponding section in the written application: Emergency Contact, Spouse, Other Teen Challenge programs in which I have been enrolled, Attorney, and Probation/Parole Officer.
14. I understand the staff and volunteers of Sheepgate are not professional counselors and are not licensed or certified by any state entity. They are committed Christians who will share their honest opinions, advice and counsel based on Biblical principles.
15. I understand that Sheepgate policy is to maintain the confidentiality of all private
communications between Sheepgate staff and myself. Generally, such confidential communications will not be disclosed to third-persons outside Sheepgate, including my family members, unless required by law. Sheepgate has no duty to notify or inform my family members about any problems discussed in counseling. If Sheepgate staff do make such disclosures as they believe are in my best interest, I waive any objection to such disclosures.
16. In consideration for the opportunity to obtain this help, I promise that I will not take any legal action in the future for anything said, done or omitted by the organization of Sheepgate, their staff, agents or family members during this program. I agree to hold Sheepgate, their staff, agents and family members harmless for any legal claims of negligence or damage of any sort, which a person could assert related to the Sheepgate program.
17. I understand that if I need Sheepgate to provide transportation to personal appointments, funds will be withdrawn from my personal account to cover transportation costs. (Please refer to page 7 of the Student Guidelines for the complete policy.)
