Contact Info For Children
Please specify who your main contact will be during your stay at CRD and provide information if it is someone different than the list above.
Provide docket and/or citation numbers; Court name and address; Any legal counsel's contact information; upcoming court dates.
Provide docket and/or citation numbers; Court name and address; Any legal counsel's contact information; upcoming court dates.
A doctor's note, on their office stationary, stating the specific physical limitations(s) is REQUIRED before admission to the program. The note should be submitted with this application.
Although we understand health is important, we also understand that it has not been the main focus of the applicant's life. During the initial six months of the program we do not schedule regular dental or health check-ups. CRD is not staffed to transport residents to and from medical appointments; therefore, any medical and/or dental needs must be addressed prior to entry into the program. In the event of an emergency, we will escort residents to the dentist/doctor.
Person responsible for Medical/Dental Bills received/incurred while in our care
Life sustaining medications only! (e.g. Heart or Blood Pressure)
Psychotropic medications are NOT life sustaining medications. CRD is a program for men and women who are willing to look to the Lord to help them with/through emotional matters rather than using medication. CRD is not a medical facility. If you are currently taking medication and desire to be in the program, you must contact your doctor and bring with you a safe step down process and adequate medication to complete that process.
Birth control is NOT allowed at CRD except for medical purposes, with a note from your doctor.
If you have no insurance and require emergency medial assistance, application can be made for charity care with a certified birth certificate.
Background Investigation Consent
I hereby authorize Calvary Residential Discipleship, Blessed Hope and/or its agents to make an independent investigation of my background, character, criminal, or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Questionnaire and/or obtaining other information, which may be material to my acceptance into residential discipleship.
Release of Liability & Conditions
Open the following link and read the document carefully. In addition, please print a copy of this document and follow the instructions contained therein.
(This Link will open a new window or tab. Simply close the new window or tab to return to this application.)
Click This Link to Read the Release of Liability
I hereby release and discharge CRD and Calvary Chapel of Bangor, it’s ministry homes, farms, owners, staff agents, landlords, other residents, heirs, guardians and legal representatives; from all liability for injury, damage, or sickness sustained at CRD or while a resident therein. I further understand any medical/dental attention and related bills are my sole responsibility.
I understand that CRD is a religious, Biblically based organization, a ministry of Calvary Chapel Bangor. The purpose of CRD is to make disciples of Jesus Christ. Our desire for our students is that they become people of honor, prepared to take their place, first of all, in the fellowship of believers (regular church attendance) and secondly, return to live and work, brush shoulders with the rest of the world while remaining clean... Our definition of "Clean" means no alcohol, no use of drugs, and no smoking.
Furthermore, CRD is not licensed by the State of Maine as a drug treatment program.
Donation Information and Agreement
A $5000.00 donation will be turned in prior to your program entry. A money order or cashier’s check is required. No personal checks will be accepted. This donation is non-refundable. If the resident leaves the program for any reason, there will be no refund of any part of this donation. In situations of hardship a financial contract may be negotiated with program administrator.
