Discipleship Recovery Program Application
Freedom Dream Center
Check in Procedures
- Applicants must have a blood test for HIV and HEP-C. Freedom Dream Center cannot accept anyone testing positive for HIV, ARC, or AIDS.
- Currently the Lawrence County Health Dept will test for HIV at no cost. You are responsible for HEP-C testing. FDC will not finance the testing for HEP-C.
- Applicants must have financial support. Please have your support system consider all sources such as friends, family, or a sponsor (your home church for example). The housing fee of the Freedom Dream Center is $300.00 per month. A $100.00 fee will also be charged upon admittance for the initial class material that will be required.
- Applicants must completely fill out all required forms as well as read and agree to all rules and regulations.
- Applicants, who are pregnant, must set up a meeting with the Administration of the Dream Center to determine if you qualify.
- No cell phones, lighters, cigarettes, tobacco, alcohol, unapproved medications, or illegal drugs will be tolerated at any time. We DO NOT allow any weapons at any time. Violators will be subject to immediate dismissal.
Schedule an appointment with the Administrator for an entrance interview by phone before coming. Do not just show up, we may not have a bed available!
Freedom Dream Center Admission Agreement:
- Freedom Dream Center is a residential Christian discipleship program. It consists of at least 12 months of instruction. Applicants must commit to complete the entire program in order to be approved for admission.
- Possession and/or use of drugs, alcohol and tobacco are prohibited while enrolled in our program. Students may be given drug and/or alcohol tests at any time without prior notice. Students who test positive for drug and/or alcohol use while in our program will face disciplinary action and possible expulsion for the program.
- Students may not lend, buy or sell personal property to or from other students. Freedom Dream Center will not be responsible for any personal property that becomes lost, stolen or damaged while on our premises.
- Students, their rooms, and their personal property may be searched at any time without prior notice.
- Students do hereby declare that any authorized staff member of Freedom Dream Center may open any incoming or outgoing mail.
- I will not hold Freedom Dream Center responsible for any action taken, concerning myself, while I am participating in the program. I will not file any legal charges or take any legal action, at any time, against Freedom Dream center, or any authorized staff member. i release Freedom Dream Center from all financial and legal responsibilities in case of accident, injury, illness or other misfortune.
- Upon leaving Freedom Dream center, I will take my personal belongings with me. I will not expect Freedom Dream Center to be responsible for my possessions or to forward them to me.
- If I fail to complete the Freedom Dream Center program, I will not contact students in the program, their families, or any person I have met as a result of my participation in the program for at least a 12 month period.
- Because of the high risk group, I understand that I may be housed with someone who is HEP-C positive. For this reason, I will practice good daily hygiene.
Dream Center Discipleship
I, _______________, understand that my acceptance as a disciple in the FDC Discipleship S.U.C.C.E.S.S. Program (“Program”) requires the following:
- HOUSE RULES, MORAL STANDARD, AND WITHDRAWAL FROM SUBSTANCE. I have read and understood that any and all House Rules as provided to me, and understood that such House Rules may be amended upon the Program’s discretion, with or without notice. Accordingly, I agree to abide by all Program’s rules, including but not limited to the House Rules as given to me.In addition, I agree to abide by the moral standards as upheld in the Bible. I understand that all forms of sexual activity outside of marriage between a husband and wife are prohibited and will abide by such accordingly. Furthermore, I understand that the Program is drug and alcohol free, but does not serve as a detoxification facility. Accordingly, I agree to withdraw from any and all substance dependence voluntarily and without the use of medication.
- MEDICAL RELEASE. I hereby authorize the Program to make arrangements for any emergency medical assistance that may be required due to any illness or injury on my part.
- DCD HEP-C/HIV POLICY. FDC Discipleship. (FDCD) does not discriminate against those who are HEP-C/HIV Positive in its intake procedures. Because a large number of IV drug users have been infected by the HEP-C and/or HIV Virus, at any given time there may be one or more students in the program that are HEP-C/HIV Positive. This program does not require students who are HEP-C/HIV Positive to notify other students in the program that are HEP-C/HIV Positive.
- Staff Members are forbidden without written permission of the student to discuss the disposition of any student on his/her caseload; other than those individuals that are involved in the treatment process.
- FDCD is not a medical care facility and is unable to provide twenty-four hour on-site medical supervision. Therefore, all students entering the program must be in good health and able to participate in all activities in the program. If a student’s health deteriorates to the point where he/she is no longer able to participate in the daily activities of the program, or medical condition requires twenty-four hour medical supervision, that person should leave the FDCD program.
- HEP-C/HIV Positive students that intentionally puts another person at risk of being infected with HEP-C/HIV cirus should be immediately dismissed from the program.
- RELEASE OF CONFIDENTIAL CASE FILE AND COPYRIGHT TO PERSON AND STORY. I hereby release and grant the Program, it’s agents, affiliates or third party as designated by the Program all rights to use and publish for any lawful purpose whatsoever to promote the Program’s purpose my: 1) confidential information as contained in my Program’s case file; 2) personal story; and 3) name, likeness, or appearance. I understand that I may also be requested to speak at public gathering, give testimony or participate in the Program’s activities whereby I may be recorded in any form or manner. Accordingly, I hereby release and grant the Program to use such recordings of me whatsoever to promote the Program’s purpose. I also hereby waive any right to inspect or receive a copy of the finished product.I hereby release and discharge the Program, it’s agents, affiliates or third party as designated by the Program any and all liability by virtue of misprint, error or distortion that may occur unless it can be shown that such error, misprint, or distortion were maliciously based. I further understand that I will not be compensated in any form or many for any and all use of my: 1) confidential information as contained in my Program’s case file; 2) personal story; and 3) name, likeness, or appearance.
- RELIGIOUS REQUIREMENTS. I understand that the program is a Christian based ministry program to assist people with life controlling problems. Through my participation in this program, I agree to submit to the Program’s religious expectations and attend the Program’s religious activities.
- CONSENT TO DRUG TESTING AND CONTRABAND WEAPON SEARCHES. I understand that the Program is a drug and weapon free facility for the safety and well being of all it’s residents, employees, and volunteers. Accordingly, by my participation and consent below, I hereby voluntarily consent to all drug tests on myself and all contraband and weapon searches of me and my living quarters upon request. I understand that the results of my drug tests, if any, will only be disclosed to the Dream Center and all legal authorities the Dream Center deems necessary. I understand that if I am tested positive for any banned drugs that are listed in the Dream Center’s Drug Testing and Contraband Search Procedure brochure, the Dream Center may terminate my participation in the Program. Furthermore, the Dream Center may terminate my participation if there are any drugs, contraband items or weapons found in my living quarters or on my person.
Freedom Dream Center
AUTHORIZATION, CONSENT AND RELEASE FORM
I _________________ am choosing to enter the Life recovery program known as the Freedom Dream Center. I understand that to aid in my recovery that for a period of 30 days all contact such as visits, letters and telephone conversation are suspended as I focus on my recovery. After that time, my phone calls and mail are reviewed to prevent negative influences, which would impede my progress and are subject to refusal. Conversation or letters, which glorify the past way of life or are abusive or do not meet the standard set by Ephesians 4:29 & Philippians 4:8, will not be allowed. As the recovery process continues home visits will be allowed on an individual request basis. Your family is encouraged to attend church services and may visit with you after service and even take you out for lunch, (Please arrange for these in advance.) In the event that you should decide to leave the program prior to graduation, there is a required procedure to be followed. We will not assist a person in leaving if they choose to leave without being properly dismissed from the program. In keeping with that, if a person leaves any of their belongings we are not responsible for them. You confirm that you have the legal right to execute this document. Furthermore, I stipulate that I have been informed that in conjunction with my attendance at Freedom Christian Center/Freedom Dream Center, I may participate in certain activities that may carry some risk or danger. These activities may include, but are not limited to, physical activities, sports, field trips, travel by motor vehicle, camping, hiking, use of recreational equipment, activities in and around bodies of water, and other activities of similar risk and danger.
I hereby willingly consent to my participation in these activities and acknowledge that this agreement is equally binding whether or not a fee for a particular activity. In consideration of my being allowed to participate in these activities and to use the equipment and facilities of Freedom Christian Center/Freedom Dream Center, I wholly release, forever discharge, and agree to indemnify and hold harmless from any and all claims, demand and causes of action which result directly or indirectly from my participation in any of these activities or from the use of equipment and facilities of Freedom Christian Center/Freedom Dream Center, including it’s pastors, board, employees, agents, and volunteers.
I authorize, in case of emergency, the examination or treatment by any health care profession licensed to practice medicine or provide health care services in the state in which the emergency occurs. Furthermore, I accept the responsibility of all charges incurred and agree to indemnify Freedom Christian Center/Freedom Dream Center including it’s pastors, board, employees, agents, volunteers and the health care professional and/or the health care institution that provides such services.
By signing this agreement, I acknowledge that I have waived any rights that I might have to maintain a lawsuit against Freedom Christian Center/Freedom Dream Center, it’s pastors, board, employees, agents, volunteers arising from any claim resulting from an activity or situation covered under this document. I also understand that if any portion of this document shall be found to be void, all other portions will remain in full force and effect.
I certify that I have carefully, read, and understand and agree to the foregoing Authorization, Consent, and Release Form and agree that a copy of this application will be valid as the original.
DISCIPLE RELEASE STATEMENT
I, ________________, understand that my acceptance as a disciple in the DC Discipleship Program (“Program”) requires the following:
- I am a volunteer participant and not an employee of the Dream Center, DC Discipleship or any of it’s affiliates. I further understand that under no circumstances can the Dream Center, DC Discipleship or any of it’s affiliates be under any obligation to me.
- I understand that my admission and continued residence in the DC Discipleship program is dependent upon my needing such assistance and my willingness to help myself and others so situated, including the voluntary performance of such duties as may be assigned to me.
- I am aware of the hazards and risks to my person and property associated with being a part of this Program. Such hazards and risks may include, but are not limited to, death, injury by accident, disease, weather conditions, inadequate medical services and supplies, criminal activity, and random acts of violence. I voluntarily assume all risks of death, injury, and illness associated with such risks, and any damage to my personal property. I further understand that the Dream Center, DC Discipleship or any of it’s affiliates may not have any insurance coverage that would apply in the event of my death, illness, injury, or damage to my person or property that may occur during my participation in the Program. If I desire insurance coverage, I understand that I am responsible for obtaining and paying for the cost of such insurance.
- I release the Dream Center, DC Discipleship, and it’s affiliates, agents, officers, directors, employees and volunteer staff from any liability whatsoever arising as a result of death, injury, or illness that I may suffer as a result of my participation in the Program.
- I attest and certify that I have no medical conditions that would prevent me from performing my duties as a volunteer participant.
- I expressly waive any defense to the enforcement of any provision of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal valid and binding obligation upon me enforceable against me in accordance with it’s terms.
- I expressly agree that this assumption of risk agreement is intended to be as broad and inclusive as permitted by law. I further state that I HAVE CAREFULLY READ THE FOREGOING ASSUMPTION OF RISK AND UNDERSTAND IT’S CONTENTS, AND I VOLUNTARILY SIGN THIS RELEASE AS MY OWN FREE ACT. THIS IS A LEGAL DOCUMENT AND I UNDERSTAND THAT I HAVE THE OPPORTUNITY TO CONSULT WITH AN ATTORNEY BEFORE SIGNING IT.
Freedom Dream Center
Financial Responsibility Agreement
I _________________ agree, understand, and commit to the payment of a $300 dollar monthly housing fee for the length of my stay. All housing fees are paid monthly and are non-refundable. If during the course of my stay I choose to leave there is no refund of the remainder of the months housing fee. Occupancy or reservation for any time in a month is considered a commitment for the entire month. The residency fee is due upon entry and then the first of each consecutive month.
I certify that I have carefully read, understand, and agree to the foregoing Authorization, Consent, and Release form and Financial Agreement and that a copy of this agreement will be valid as the original.
What to bring?
The following items are helpful but not required. If you do not have any of the items listed below, we will be able to provide you with the basic items needed. Please bring the basics because there is not enough space to accommodate a mass amount of items.
Clothes must be modest and appropriate. There will be no secular advertising (secular bands, alcohol, etc.) Due to the limited space we have, we ask that disciples only bring 2 weeks worth of clothing and that seasonal items will be sent home
- Casual Clothes – Every day clothes that you will feel comfortable in (jeans, shirts, tennis shoes, flip flops, work clothes, undergarments-must be worn, etc.)
- Business Casual Clothes – For services we ask that our disciples wear business casual clothes (dress shirt, slacks, dresses, etc.)
- Personal Items – Items that will help with the personal upkeep (deodorant, cologne/perfume, feminine product, toothbrush, toothpaste, razors, etc.)
- Shower necessities – shampoo, conditioner, soap, towels, shower cubby, etc.
- Bedding – Items desired for your bed (twin sheets, pillows, blankets, etc.
- Organizers – Laundry basket, hangers, etc.
- Decoration – Small items to help make your space yours (pictures, letters, etc.)
- Index Cards
- Pens or Pencils
- Spiral Notebooks
- Envelopes & Stamps (after the first 30 days students may receive and send approved mail).
- Drinks – Soda pop, bottled water, etc. No energy drinks.
All students, rooms, personal property will be searched by staff upon check-in and at any time without prior notice during the students stay at FDC. Students may not lend, buy, or sell personal property to or from other students. FDC will not be responsible for any personal property that becomes lost, stolen, or damaged while on our premises.