This application form will take approximately 15 minutes to complete.
You will need the following documents:
Once you've got the documents, and are ready to begin, hit the "Next" button below.
Men’s piercings must be removed prior to program entry. For women, earrings only are permitted; other body piercings must be removed prior to program
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 Adult & Teen Challenge residential discipleship program.
5. I release to Adult & Teen Challenge to right to search, read and withhold my mail in the manner explained in the Student Guidelines.
6. I release to Adult & Teen Challenge the right to conduct a room search without warning.
7. I release to Adult & Teen Challenge the right to make a thorough search of my person and belongings on the day ofadmission.
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 Adult & Teen Challenge will not be held responsible for any of my personal property that is lost or stolen while I am in the program. When leaving Adult & Teen Challenge, 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 Adult & Teen Challenge from all financial and legal responsibilities in case of accident, injury, illness or other misfortune.
11. Any items that are brought to Adult & Teen Challenge 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 privatecommunications between Adult & Teen Challenge 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 Teen Challenge of the Midlands program.
17. I understand that if I need Adult & Teen Challenge 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.
The undersigned parties enter into this agreement as an essential condition of participation in the Sheepgate program.The undersigned parties accept the Bible as the inspired Word of God. They believe God desires for themto resolve disputes with one another within the church and that they be reconciled in their relationshipsin accordance with the principles stated in I Corinthians 6:1-8, Matthew 5:23-24, and Matthew 18:15-20.Accordingly, the undersigned parties hereby agree that, if any dispute or controversy that arises out of oris related to this agreement is not resolved in private meetings between the parties pursuant to Matthew5:23-24 and Matthew 18:15-20, then the dispute or controversy will be settled by Biblically basedmediation and, if necessary, legally binding arbitration, in accordance with the “Rules of Procedure forChristian Conciliation” of the Association of Christian Conciliation Services, a division of PeacemakerMinistries. (Current Rules attached and incorporated by this reference and we will also mail a copy of therules upon request).Rules may be found at www.hispeace.org or by contacting Peacemaker Ministries:PO Box 81130Billings, MT 59108(406) 256-1583The undersigned parties agree that these methods shall be the sole remedy for any dispute orcontroversy between them and, to the full extent permitted by applicable law, expressly waive their rightto file a lawsuit in any civil court against one another for such disputes, except to enforce an arbitrationdecision, or to enforce this dispute resolution agreement. Any mediated settlement agreement orarbitrated decision hereunder shall be final and binding, and fully enforceable according to its terms inany court of competent jurisdiction.
I understand that if I am admitted as a student, I will be required to participate in the Sheepgate Work Therapy Program.
I acknowledge that I have read and fully agree with the Sheepgate description of its WorkTherapy Program, which addresses the importance of work assignments in helping create in me the valueof a good work ethic and the character of a responsible, upright individual.
I understand that if I am admitted, I will be performing work assignments not as an employee of Sheepgate, but solely for my benefit, to advance my growth, maturity, characterdevelopment, recovery from controlled substances, and readiness to reenter the work place.
Accordingly, by submitting this Application, I am not applying for a position of employment, and ifadmitted, I understand I will not be receiving any compensation or in-kind benefits in exchange for theperformance of any work assignments.
I further understand that if I fail to perform my work assignments, Sheepgate may revoke my status and privileges as a student. It is understood that performance of workassignments are not the consideration for the receipt of such status and benefits, but because eachstudent’s participation in the Work Therapy Program is a necessary and vital part of the recoveryprocess.
We do not maintain storage space for excess clothing. Student who arrive with an excess amount of clothing for available space (2 storage totes under bunk, 30” of hanging space) will be asked to return items home or send them home at their own expense.
Students who do not have all the items listed will have access to new/donated items in our facility to help fulfill needs if necessary. Your person, bags, and possessions will be searched upon intake and all clothing items will be laundered in our onsite laundry.
Please do not bring any of the following items with you on the day of intake – you will be asked to have them returned
home with your family or to send them home at your expense:
If you require more information, and/or assistance, please contact us at: email@example.com
(515) 674-3713 Ext. 206