Teen Challenge of Vero Beach

______(initial) TEEN CHALLENGE OF VERO BEACH WELCOMES YOU! 801 154TH Avenue Vero Beach, FL 32966 (772) 978-4164 Fax (772) 299-7424

As a father of 2 grown sons I know the pain of dealing with a troubled teenage boy. My youngest son spent many years in rebellion. It was difficult for both him and his family. We now enjoy his work for the Lord as he ministers to others in need.

 Read carefully and complete the application in its entirety. Return the completed application along with a written “bio sketch” of your child. Give specific information regarding any legal changes. Sign and date the biography, please.

 Have the following medical testing done either with a family physician or at your local Health Department and forward the results to Teen Challenge:

o TB Skin Test o Blood Tests for HIV, VDRL o Hepatitis B Titer o Dental Examination/Evaluation

 Have a School Sports Physical completed and have the results forwarded to Teen Challenge. This is a state mandate for all Florida Schools.

 Enclose a copy of your son’s up-to-date- Immunization Record. (Including the date of the most recent Tetanus Shot)

 If your son has had counseling, testing or placement in other facilities, please send the evaluations and reports to us as soon as possible.

 Submit a copy of your son’s birth certificate, social security card and insurance card.

 Submit a $750.00 one-time administrative fee (non-refundable) in the form of a Cashier’s Check or Money Order with your application. Only Original Applications with be accepted, please send the original application via UPS or FED EX attention: Maynard Sweigard, Executive Director.

 The first and last month’s tuition, total $6,900.00 ($3.450.00/month), is to be submitted when the application is approved and before induction date is confirmed. The initial payment must be in the form of a Cashier’s Check or Money Order. The induction date will not be held with a down payment. Subsequent tuition payments can be made with personal check or credit card. (See Financial Agreement for additional information)

1 (Rev. 11/19/15) ______(initial)

 A separate Cashier’s Check or Money Order in the amount of $3,150.00 is to be submitted for school curriculum, ankle monitor, and incidentals. ($2,650.00 school curriculum fee and $500.00 student personal account) The cost varies but this is within a few hundred dollars of the amount we will spend for the schooling portion of your son’s stay with us. If we do an extra activity outside the program that has a significant cost we may call for financial assistance for the activity. See Financial Agreement for additional information)

For any questions or concerns concerning intake, please call (772) 978-4164. Maynard E. Sweigard, Executive Director

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Teen Challenge Vero Beach

STATEMENT OF FAITH

As a Christian organization, we regard the following statements as our sound doctrine of faith, based upon the holy and inspired word of God, the Bible. All students enrolled at Teen Challenge of Vero Beach are required to attend chapel services, Sunday worship services, and participate in the Teen Challenge International Christian character building curriculum.

We believe that the scriptures are inspired by God and declare His design and plan for mankind. II Timothy 3:15-17

We believe there is only one true God, revealed in three persons…Father, Son, and Holy Ghost. Matthew 28:19 / Isaiah 43:10-11

We believe in the Deity of the Lord Jesus Christ, that as God’s Son, he was both human and divine. Matthew 1:23 / Philippians 2:9-11

We believe that man willingly fell into sin, ushering evil and death, both physical and spiritual into the world. Romans 5:12-19

We believe that every person can have a restored fellowship with God through salvation, by accepting Christ’s offer of forgiveness for sin. Acts 10:37 / Romans 10:13-15 / Ephesians 2:8-9

We believe in water baptism by immersion after repenting of one’s sins and receiving Christ’s gift of salvation, and in the Holy Communion, (the Lord’s Supper) as a symbolic remembrance of Christ’s suffering and death for our salvation. Matthew 28:19 / 1 Corinthians 11:26

We believe the Baptism in the Holy Spirit is a special experience following salvation. Acts 1:4, 8 / Mark 16:20

We believe that the physical evidence of the Baptism in the Holy Spirit is “speaking in tongues” as experienced in the book of Acts. Acts 2:4 / 1 Corinthians 12:4-10

We believe that sanctification initially occurs at salvation and is a progressive lifelong process of separation from evil. Romans 12:1-2

We believe that the “Church” is the body of Christ and consists of those people, throughout time, who have accepted God’s plan of redemption (regardless of religious denomination) through the sacrificial death of His son Jesus Christ. I believe this Church

3 (Rev. 11/19/15) ______(initial) has received the Great Commission to go into all the world to share the Gospel of Jesus Christ. Ephesians 1:22-23 / Hebrews 12:23

We believe in a divinely called and scripturally ordained leadership ministry that serves the Church, i.e. apostles, prophets, pastors, teachers, evangelists. Mark 16:15-20

We believe that divine healing of the sick was provided for in Christ’s atonement. James 5:14-16

We believe in the “blessed hope” – when Christ raptures His church prior to His return to earth (the Second Coming). 1 Thessalonians 4:16-17

We believe in the millennial reign of Christ when He returns with His saints at His second coming. And at that time the nation of Israel will accept Him as Messiah. Matt 14:27, 30 / Revelation 1:7

We believe that a final judgment will take place for those who have rejected Christ. They will be judged for their sin and consigned to eternal punishment in a lake of fire, a literal place called hell. Matthew 25:46 / Revelation 19:20

We believe in and look forward to a perfect New Heavens and a New Earth that Christ is preparing for all people, of all time, who have accepted Him as their personal Lord and Savior. We will live and dwell with Him there forever following His millennial reign on earth. 2 Peter 3:13 / Rev 21:22

TEEN CHALLENGE 4 (Rev. 11/19/15) ______(initial) Vero Beach Boys Ranch PLACEMENT AGREEMENT

It is understood by the Second Party, parent/legal guardian, that in addition to providing room, board, and education of the child while in the program, Teen Challenge is primarily organized, as its program, to develop not only the physical, emotional, and academic qualities of the child, but his spiritual development as well. As for the other accommodations provided, the Second Party acknowledges by the signing of this agreement, that the said Second Party has been given a personal tour of the facility and has, by personal observation, been made aware of such accommodations that are not herein specifically listed.

Second Party voluntarily and unconditionally, without coercion or force, relinquishes and conveys the care, custody of said minor to Teen Challenge expressly appointing Teen Challenge as lawful attorney for said Second Party and in Second Party’s name, place, and stead for and to serve on loco parentis (in place of Second Party) of said child for his care, custody, safety, education, and training (both secular and religious) and for all other responsibilities, real or legal, including all necessities which Teen Challenge deems essential for the said child. This grant of custody and control shall commence upon the signing of this agreement, by the last party hereto and shall terminate as hereinafter provided.

Teen Challenge agrees to accept the care and control of said minor child while he is on the said property of Teen Challenge for the period and under the terms and conditions herein provided. Second Party agrees not to interfere with the custody or management of said minor in any way and shall not encourage anyone else to do so. Second Party also agrees to support Teen Challenge positively at all times.

Both Teen Challenge and Second Party understand and agree that (15) months is the minimum requirement for completion of the program and that time may be added if the need arises. However, failure of child to adjust or conform to the Teen Challenge program could result in termination of the agreement prior to the specified termination date and without prior notice to the Second Party.

Teen Challenge does not discriminate against those who are HIV+ in its admissions procedures. Second Party understands that Teen Challenge is not a medical care facility and is unable to provide 24 hours 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. Second Party further agrees that cooperation with Teen Challenge, not only in monthly financial support, but also in the personal participation of passes, parent meetings, etc. is essential to the success of the attempt by both the Second Party and Teen Challenge to rehabilitate the minor child.

Second Party acknowledges that Teen Challenge accepts students at the age of 17 that may not complete the entirety of the program prior to their 18th birthday. Teen Challenge and Second Party acknowledge students will be allowed to participate and complete the entire program after their 18th birthday, if necessary.

Teen Challenge Anderson Academy is a member of the:

5 (Rev. 11/19/15) ______(initial) Alpha Omega Academy, which is, accredited through AdvancedED, the parent organization of The North Central Association Commission on Accreditation and School Improvement (NCA CASI), Northwest Accreditation Commission (NWAC), and the Southern Association of Colleges and Schools Council on Accreditation and School Improvement (SACS CASI). Anderson Academy and Alpha Omega Academy are also members of the Association of Christian Schools International (ACSI). Anderson Academy is a member of the Coalition for Residential Education Anderson Academy is a member of The Florida Department of Education

Except as hereinafter specifically provided and except for a possible renewal or extension of the same, this contract will terminate on the ______day of ______, 20___. Notwithstanding anything herein contained to the contrary, however, violation by the Second Party of any of the above terms and conditions shall entitle Teen Challenge to terminate this agreement prior to the specified termination date and without prior notice to the Second Party.

This contract made and entered this day by and between Teen Challenge, engaged in the care of minor children in a Christian Boarding School, and

______, parent(s)/legal guardian(s) of ______, (the child) whose address is:

______

IN WITNESS THEREOF, the undersigned have read and agree with the above contract between the Second Party and Teen Challenge.

______

Parent/Legal Guardian Date

______

6 (Rev. 11/19/15) ______(initial) Notary Public Commission ExpiresTEEN CHALLENGE VERO BEACH FINANCIAL AGREEMENT

The Second Party, parent/legal guardian, covenants and agrees to assist in the support of said minor child while in the custody of Teen Challenge through tuition in the sum of $3,450.00 each month. The first such payments being due on the day of enrollment, and with subsequent payments being due on the like day each month, thereafter as long as this agreement is in effect.

Teen Challenge collects the school curriculum fee of $2,650.00 at the time of admission. The curriculum fee includes the cost of the school curriculum, ankle monitor and incidentals relating to the education of your son. The cost may vary but this is within a few hundred dollars of the amount we spend for these items. If we do something extra outside the program that has a significant cost we may call for help to assist with off setting those costs.

In addition, an Admission Fee of $750.00 is required at the time of admission.

Every student has special needs from time to time. These needs are paid through a Student Cash Account established for him. A $500.00 cash deposit must be made on the day of admission and replenished periodically as needed. The Student’s Cash Account will be used for various out of pocket expenses that will arise from various field trips and transportation costs to and from town as it relates to the student.

FIRST MONTH’S ENROLLMENT FEES

(CHECK #1 (Tuition):

FIRST MONTH’S TUITION $3,450.00

LAST MONTH’S TUITION (15 MONTH) 3,450.00

ADMISSION FEE 750.00

TOTAL CK #1 $ 7,650.00

(CHECK #2 (Student Account):

CURRICULUM FEE $2,650.00

STUDENT PERSONAL ACCOUNT 500.00

TOTAL CK #2 $3,150.00

Total for both checks $10,800.00

7 (Rev. 11/19/15) ______(initial)

ALL FEES ARE NON-REFUNDABLE. Second Party understands and agrees that whether said minor child remains in Teen Challenge for one day or the full fifteen (15) months, none of the tuition fees, school curriculum fees and admission fees are refundable. There will be No pro rating of tuition upon early withdrawal.

Second Party understands that tuition alone does not fund the entirety of this program. Therefore, timely monthly tuition payments are critical to the service we provide to students and families on a daily basis. Teen Challenge provides a grace period of five business days for tuition payments. After five business days, a $50.00 late fee will be charged and added to your next monthly tuition statement.

This is a legally binding agreement, which I have read, understand, and agree to.

______

Notary Public Commission Expires

8 (Rev. 11/19/15) ______(initial) Teen Challenge Vero Beach STUDENT APPLICATION Personal Data

Student Name ______(Last) (First) (Middle)

Address ______

______(City) (State) (Zip)

Phone ______Cell ______Work ______

Date of Birth ____/____/____ Age ______

Weight ______Height ______Hair color ______Eye color ______

Social Security Number ______

Driver’s License: Y N If yes, number ______

Race ______American Citizen? ______If no, explain: ______

EMERGENCY (Other than parent or guardian) Notify: ______Relationship ______Phone: (home) ______(work) ______(cell) ______

Who referred you to Teen Challenge?

Name ______Phone ______Address ______Relationship ______

9 (Rev. 11/19/15) ______(initial) Teen Challenge Vero Beach Student Profile

To the best of your knowledge, which of the following has your son abused?

___ Alcohol ___ Barbiturates ___ Methamphetamines ___ Heroin ___ Cocaine ___ Hallucinogenic ___ Glue ___Marijuana ___ Freon ___ Opium ____ Mushrooms ___ Crack Other ______

IMPORTANT NOTICE! NO PSYCHOSOMATIC DRUGS WILL BE ADMINISTERED AT TEEN CHALLENGE OF VERO BEACH! Students who have been prescribed MOOD STABILIZING drugs, such as but not limited to, Prozac, Ritalin, and Adderall need to obtain a written release OR STEP DOWN PLAN from the prescribing Physician PRIOR to entering the program.

Check all that apply and indicate moderate or severe where appropriate:

Severe family conflicts with _____ Mother _____ Father _____ Step-parent(s)

Self-destructive: _____ Suicide attempts _____ Suicide threats Other ______

Depression: _____ Major _____ Mild _____ None apparent

Attention Deficit: _____ Inattentive _____ Hyper _____ Impulsive _____ Medicated for ADD/ADHD

Aggressive behavior: ____ bullies, threatens, intimidates _____ physical violence, destruction of property

Has the applicant ever been arrested or investigated by law enforcement or does he have a police record? ______if yes, please explain: ______

Is the applicant on probation? _____ yes _____ no Probation Officer’s name: ______Telephone: ______

Has the applicant or any other member of your family been involved/supervised by a social service agency such as Children & Families? If yes, please explain: ______10 (Rev. 11/19/15) ______(initial)

Parental Contact Information

Please provide the following information in case of an emergency.

Which parent has legal custody? ______Mailing address ______

Biological Father’s Name: ______Home phone number: ______Cell phone number: ______Work phone number: ______Work fax number: ______Home email address: ______Work email address: ______

Biological Mother’s Name: ______Home phone number: ______Cell phone number: ______Work phone number: ______Work fax number: ______Home email address: ______Work email address: ______

Stepfather’s Name: ______Home phone number: ______Cell phone number: ______Work phone number: ______Work fax number: ______Home email address: ______

Stepmother’s Name: ______Home phone number: ______Cell phone number: ______Work phone number: ______Work fax number: ______Home email address: ______

Guardian’s Name: ______Home phone number: ______Cell phone number: ______Work phone number: ______Work fax number: ______Home email address: ______

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TEEN CHALLENGE VERO BEACH

CUSTODIAL REQUIREMENTS

Teen Challenge requires a copy of custodial documents for each student. Students will NOT be enrolled in the program without these documents. Please refer to the following and check the status that applies to your situation:

____Married – Both biological parents have custody, no papers required.

____ Divorced – Full custody to one parent. A copy of the divorce decree is required. The custodial parent must sign all of the Student Application and Placement Agreement forms.

____ Divorced – Physical custody to one parent with stipulation that both parents jointly make decisions regarding schooling and child’s future needs. A copy of divorce decree is required. (Custody papers) Both Parents must sign all of the Student Application and Placement Agreement forms.

____ Guardian – Papers showing legal guardianship over student required. .

____Ward of Court – Documents declaring student is assigned by court or state.

The information we have will be kept confidential, except when necessary to share with medical or legal personnel. We will, at times, have to share medical information with medical personnel or legal information with the courts. It is necessary for us to identify the legal guardian at the time of induction so we can make the appropriate contact with parent(s), custodial parent, or guardian.

12 (Rev. 11/19/15) ______(initial) Teen Challenge Vero Beach

Personal Family History

List brothers and sisters: (use back if necessary)

Name Relationship Age Residence

______

Father’s name/address: ______Occupation: ______

Mother’s name/address: ______Occupation: ______

Parent’s marital status: Married _____ Divorced _____ Separated _____ Living together _____ Remarried _____ How long? ______

Has any other individual raised your son for a period of time? Please explain: ______

When did your son last live with you? ______

Has he ever accused a close family member of physical or sexual abuse? _____ yes _____ no

If yes, who, when and what was done about it? ______

To the best of your knowledge, what is your son’s sexual lifestyle? ______

Heterosexual _____ Homosexual _____ Bi-sexual _____

Pornography _____ Child Pornography _____ Incest _____

How recently involved? ______

Has your son previously been enrolled in a boarding or military school? ______If the answer is yes, please enclose a reference from such school.

Teen Challenge

13 (Rev. 11/19/15) ______(initial) Vero Beach

Medical History

THIS INFORMATION IS FOR OFFICIAL USE ONLY AND WILL NOT BE RELEASED TO UNAUTHORIZED PERSONS.

NAME: ______DATE OF BIRTH: _____/_____/_____ FAMILY PHYSICIAN: ______PHONE: ______INSURANCE: Y N COMPANY ______POLICY # ______

Insured parents Social Security number ______and birthday _____/_____/_____

Has your son had any of the following? Please check all that apply:

_____ Heart disease _____ Kidney disease _____ STDs _____ Allergies _____ TB _____ Kidney infection _____ Seizures _____ Diabetes _____ Hay fever _____ Back or neck injury _____ Leg or hip injury _____ Sinus trouble _____ Shortness of breath _____ Asthma _____ Severe / persistent headaches

A SCHOOL SPORTS EXAM is required for entrance to the program. Attach to this document!

(Out-of-state students will require a physician’s school sports exam from their state of residence.)

Describe any allergies or reactions to medications, food, etc. ______

Is your son currently on any medications or undergoing medical treatment? Y _____ N _____ If yes, list medications, treatment, and the reason why: ______

When was your son’s last eye exam? Explain any problems he may have with his eyes at this time: ______

When was your son’s last dental exam? ______

Is he currently experiencing any problems with his teeth? Y _____ N _____ Explain: ______

Medical Authorization Release

I (we), ______, do hereby authorize, Teen Challenge of Vero (Parent/Legal Guardian) Beach, as agents for the undersigned permission to transport ______and seek medical attention. (Student)

It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but it is given to provide authority and power on the part of our aforesaid agents to give specific consent to any and all such diagnosis, treatment, or hospital care which aforementioned physician in the exercise of his/her best judgment may deem advisable. Second Party assumes all financial responsibility as a result of any medical treatment.

Please be aware that my son has the following allergies: ______

______

I (we), ______, do hereby authorize Doctors or Agencies involved (Parent/Legal Guardian) In previous treatments of ______, to release any medical or (Student) psychological records of my minor child to Teen Challenge of Vero Beach.

______Parent/Legal Guardian Date

______Notary Public Commission Expires

TEEN CHALLENGE VERO BEACH

15 (Rev. 11/19/15) ______(initial)

ACADEMIC AGREEMENT

All Teen Challenge students are dually enrolled in the Anderson Academy (AA) and Alpha Omega Academy (AOA). AOA is accredited through AdvancedED, the parent organization of The North Central Association Commission on Accreditation and School Improvement (NCA CASI), Northwest Accreditation Commission (NWAC), and the Southern Association of Colleges and Schools Council on Accreditation and School Improvement (SACS CASI). AOA is also a member of the Association of Christian Schools International (ACSI).

AA and AOA utilize the web based Ignitia Curriculum that is published by Alpha Omega Publications. Designed exclusively for Christian schools, this comprehensive curriculum includes lessons in five core subject areas: Math, English, Science, History, Language Arts and also Bible, with a list of electives also available. Ignitia courses provide instruction based on a Christian worldview. Courses include text-based lessons, assignments, quizzes, tests, optional external web links, interactive learning games, audio and video clips, and off computer assignments.

Teen Challenge collects the school curriculum fee of $2,650.00 at the time of admission.

All students attending AA must be enrolled in either High School or College courses. We also offer a G.E.D. program. If your son enters our program and you agree to let him we can prepare him to take the test locally. To ensure that a student’s academic studies continue, HS seniors working on their last two subjects can be enrolled in Global University through the study center of Emerging Leader’s College. Additional information is available upon enrollment regarding college courses.

It is agreed that the Second Party accepts sole responsibility for determining what prospective school policies are regarding admissions and transferring credits. I/we have read the above notice prior to its execution and that I/we are in full agreement to the contents thereof.

______

Notary Commission Expires

16 (Rev. 11/19/15) ______(initial)

Academic History

List the highest grade completed ______

When did your son last attend school? ______

Are you currently enrolled in an education program? ___ public school ___ private ___ home study

Your first language is: _____ English _____ Spanish _____ Other: ______

Reading Skills Level: Good _____ Average _____ Poor _____ Writing Skills Level: Good _____ Average _____ Poor _____

Does your son play a musical instrument? ______Was your son involved in extracurricular activities? ______

Does your son have learning disabilities of any kind? _____ If so, what are the modifications on his IEP (Individual Education Plan)? ______

Anderson Academy

(Dear parent, please deliver this document to your son’s guidance counselor and request that his transcripts be sent or faxed to Anderson Academy at Teen Challenge.)

______School Name

______Address

______City State/Province Zip/Postal Code

______Phone Fax

Dear Counselor:

______has been withdrawn from your school. Please release their academic and health records to the following school. Please include a grading scale and high school graduation requirements. Thank you.

Accepting School

Anderson Academy 801 154th Avenue Vero Beach, FL 32966 (772) 978-4164 phone (772) 299-7424 fax

______Student’s Name Social Security #

______Grade level when withdrawn Age Date withdrawn

______Signature of Receiving Principal Date

18 (Rev. 11/19/15) ______(initial) Teen Challenge Vero Beach Admission Agreement

I agree to provide the following information to enroll my son in the Vero Beach Florida Teen Challenge program:

_____ Completed application with all notarized signatures _____ Complete Medical History including all results from the current physical exam _____ Copies of insurance cards _____ Copy of birth certificate (ORIGINAL must be submitted at induction) _____ Copy of Social Security card (ORIGINAL must be submitted at induction) _____ State issued ID (Driver’s License of State ID card from DMV) _____ Results of TB test and HIV, VDRL, and Hepatitis B Titer test _____ Up-to-date Immunization record (Include date of most recent Tetanus Shot) _____ Anderson Academy and personal account funds

DO NOT BRING ANY OF THE FOLLOWING:

_____ Aerosol products _____ Colognes _____ Cigarettes, lighters, matches _____ Playing cards, books, journals, magazines or games _____ Music tapes, CDs, radios, tape or CD players

BRING ONLY ITEMS ON THE CLOTHING and PERSONAL NEEDS LIST Body piercing is NOT ACCEPTABLE at Teen Challenge and must be removed prior to admission!

Teen Challenge provides all reading materials for the students. If families would like to donate Christian books, games, etc. please contact the Director for approval.

I (we), the undersigned, have thoroughly read and do understand this application agreement. I (we), understand that any knowingly made misstatements made on any documents, or during admissions, may result in the rejection of the applicant.

______(Parent/Legal Guardian) (Date)

19 (Rev. 11/19/15) ______(initial) Teen Challenge Vero Beach Clothing and Personal Needs for Students

It is required for the parent to supply these items when the student arrives. Most items can be purchased from Wal-Mart. _____ 2 pair of long pants (Dockers Style flat front – Tan or Khaki) _____ 3 pair long pants (Dickies brand 874 Traditional Work Pants – Khaki) _____ 2 pair long pants (Dickies brand 874 Traditional Work Pants – Black) _____ 3 pair short pants 13” (Dickies Brand Work Shorts – Khaki) _____ 2 pair short pants 13” (Dickies Brand Work Shorts – Black) _____ 3 pair sweatpants – Solid Grey _____ 3 pair basketball shorts – Solid Grey _____ 3 Sweatshirts – Navy Blue (No Logos) _____ 15 T-shirts Navy Blue (No pockets or logos) _____ 5 Navy Blue Polo Shirts _____ 12 White undershirts _____ 15 pair boxer shorts _____ 2 Long Sleeve White dress shirts _____ 2 Brown Belts _____ 20 pair White socks (10 crew, 10 ankle) _____ 2 Neckties _____ 1 pair swim trunks _____ 1 pair Brown dress shoes for church _____ 1 pair Black tennis style sneakers (All Black including trim – Plain no logos) _____ 1 pair shower shoes/flip flops Black (No logos) _____ 1 Winter Jacket Navy Blue (No Logos, No Hoodies) _____ 1 Pillow with pillow case (Tan) _____ 1 set of Twin sheets (Tan) _____ 1 Mainstay Reversible Comforter (Navy blue) _____ 2 Bath Towels (Navy blue) _____ 2 Wash Clothes (Navy blue) _____ Toothbrush _____ Norelco Razor _____ NIV or NLT version Bible _____ 3 plain white 3 ring binders – 1” _____ 3 packs of loose-leaf, college lined paper _____ 2 packs wooden pencils _____ 40 postage stamps _____ 1 box No. 10 Self-Seal envelopes ALL BEDDING AND TOWELS MAINSTAY BRAND FROM WAL-MART NO OVERSIZED WAISTS IN PANTS. WAIST MUST BE CORRECT SIZE.

It is imperative that we do not deviate from the list in order to maintain dress code consistency within our student body. We have found that the slightest deviation can develop into a status symbol. Non-regulation clothing and personal needs 20 (Rev. 11/19/15) ______(initial) items will be returned causing unnecessary and added expense. If it’s not on the list it’s not regulation.

Student’s clothes must be marked with 3 initials in two places with a permanent marker. Please label all socks on the toe with three initials.

Note: Please obtain a “Florida Freshwater Fishing License. 1. Florida residents may obtain at your local Wal-Mart, bait store, or call Florida Fish and Wildlife at (888) 347-4356. 2. Non-Florida residents can call Florida Fish and Wildlife at (888) 347-4356.

Attention All Parents: We ask that you follow this list of clothing and personal needs for students. In doing so, you will help our program run more efficiently. Most of the above items can be purchased at Wal-Mart.

21 (Rev. 11/19/15) ______(initial) Visitation Agreement

I (we) agree that it is vital to the restoration of our family for my child to be visited on the prescheduled and designated visitation days, referred to hereafter as Parent Visit Weekend. I further agree to abide by the entire Teen Challenge of Vero Beach visitation policies:

1. Students are eligible for their first visit during the fourth month of residence or at the next pre-scheduled Parent Visit Weekend following the fourth month. After the first visit Parent Weekend Visits are scheduled every two months. (A schedule is included in the Parent Handbook and is updated annually). Parents/Legal Guardians are notified by email of upcoming Parent Weekend Visits. 2. It is mandatory that all Parent/Legal Guardians attend every Parent Visit Weekend including the mandatory parent/legal guardian parenting classes. Failure to attend schedule visits and parenting classes may result in your child’s dismissal. 3. Split families must work out and acceptable agreement between the parents and notify Teen Challenge of Vero Beach of the agreement. 4. The first pass Parent Visit Weekend is for the Parent/Legal Guardian ONLY. Siblings and grandparents may visit after the first pass weekend. Parents/Legal Guardians meet with their sons on campus both Saturday and Sunday as outlined in pass rules and regulations. 5. Students are permitted a Saturday 8-hour pass off campus and a Sunday 6-hour pass off campus once they have completed at least 6 months, or as personal evaluations permit. 6. Subsequent Parent Visit Weekends are discussed in the Parent Handbook. 7. Parents/Legal Guardians are expected to strictly adhere to the Leave Agreement rules and regulations set forth in the agreement and signed by both the Parents/Legal Guardians and the student. 8. All items brought back to the ranch, as well as the student, will be thoroughly searched upon return from the off-campus passes. Non-regulation items will be confiscated and destroyed.

The purpose of the off-campus pass is not primarily for entertainment, but for the opportunity to grow together as a family unit.

“All pass as well as pass time are contingent on the student’s continual progress in the program. Passes and visits are a privilege and not a right, and can be taken away at any time for disciplinary reasons or lack of progress by the student.”

I (we), the undersigned, have thoroughly read and do understand this legally binding agreement. ______Parent/Legal Guardian Date

______

22 (Rev. 11/19/15) ______(initial) Notary Public Commission ExpiresTEEN CHALLENGE

VERO BEACH

LIABILITY CONSENT AND RELEASE

I (we) the undersigned parent/legal guardian, hereby consent to our minor child participating in all activities sponsored by Teen Challenge on or off campus property. I certify that the applicant is able to participate in all activities. I understand and hereby do agree to assume all of the risks, which may be encountered on said activity, including activities preliminary and subsequent thereto.

I do hereby agree to hold Teen Challenge and its agents and employees harmless from any liability, actions, cause of actions, claims, expenses, and damages on account of injury of any kind to the applicant, or property, or even injury resulting in death, which may arise in the future in connection or participation in any other associated activities.

I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by law and that if any portion thereof is held invalid, it is agreed that the balance shall, not withstanding continue in full legal force and effect.

I further state that I have carefully read the foregoing release and know the contents thereof and sign this release as my own free act.

______

23 (Rev. 11/19/15) ______(initial)

TEEN CHALLENGE

VERO BEACH

CHRISTIAN CONCILIATION AND ARBITRATION AGREEMENT

The undersigned parties, Teen Challenge and parent/legal guardian, enter into this agreement as an essential condition of enrollment with Teen Challenge.

The undersigned parties accept the Bible as the inspired word of God. They believe that God desires that they resolve their dispute with one another within the church and that they be reconciled in their relationship in accordance with the principles stated in 1 Corinthians 6:1-8, Matthew 5:23,24 and Matthew 18:15-20.

Accordingly, both parties hereby agree that, if any dispute or controversy that arises out of or is related to this agreement is not resolved in private meetings between the parties pursuant to Matthew 5:23,24 and 18:15, then the dispute or controversy will be settled by biblically based mediation and, if necessary, legally binding arbitration, in accordance with the Rules of Procedure for Christian Conciliation of the Association of Christian Conciliation Services.

The undersigned party agree that these methods shall be the sole remedy for any dispute or controversy between them and, to the full extent permitted by applicable law, expressly waive their right to file a lawsuit in any civil court against one another for such disputes, except to enforce an arbitration decision, or to enforce this dispute resolution agreement. Any mediated settlement agreement, or arbitrated decision thereunder shall be final and binding, and fully enforceable according to its terms in any court of complete jurisdiction.

______

24 (Rev. 11/19/15) ______(initial) Notary Public Commission Expires

Informed Consent / Confidentiality

Federal law and regulations protect the confidentiality of juvenile records maintained by this ministry. Generally, the ministry may not say to a person outside the program that a named student attends the program, nor does it disclose any information identifying a student with a life- controlling problem, especially alcohol or drug abuse unless:

 The student and parent/legal guardian consent in writing.  The disclosure is allowed by a court order.  The disclosure is made to medical personnel or legal authorities on a “need to know” basis and in a courteous and professional manner.

Violations of Federal law and regulations are a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal regulations.

Federal law and regulations do not protect any information about a crime committed by a student either at the program or against any person who works for the program or about any threat to commit such a crime.

Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State and Local authorities. I warrant that I have read the above notice prior to its execution and that I am fully familiar with the contents thereof.

25 (Rev. 11/19/15) ______(initial) TEEN CHALLENGE VERO BEACH

Discipline Policy and Procedures

We are honored that you have asked us to assist you in the training and development of your child for Christian leadership. We have specifically designed our program to develop the spiritual, academic and social qualities that our world is so lacking today. To carry out your wishes for total “character development”, we believe it is essential to follow Scriptural admonitions to correct and direct your child when he violates proper and reasonable rules and procedures. We have developed a set of guidelines-given below-that are followed when your child may need discipline: All students receive a copy of the Student Handbook, which clearly state our rules and procedures. In the event your child breaks a rule or procedure the offense will be clearly discussed with him by a staff member and the staff member will share Scriptural application with him.

Types of discipline include:

 Work: A work discipline / chore assigned to a student that is in addition to normal chores. It must be at least one hour in length.  Writing: A writing discipline is in the form of writing sentences (Character Qualities) for an assigned amount..  Scripture: A scripture discipline is an assigned report on a scripture that is relevant to the issue being addressed. It deals with the interpretation, purpose, and application of the scripture.  Relationship Restriction: Restrictions placed on a student’s relationship with other students. This is a result of students having a negative relationship, running away together and / or sharing common problems.  Loss of privileges: Loss of phone calls, mail and passes can be taken away when other forms of discipline have failed in correcting a student.  Discipline Crew (Group 2): Major infractions, continued defiance / non- compliance with program rules and / or schedule.  Discipline Crew (Group 3): Flagrant disregard for the program rules and/or schedules by continually defying staff.  Program Extension: Additional time added to length of program in order to graduate. This may result from continued disrespect to staff and others, threatening behavior, lack of progress, stealing or running away.

Minor Infractions: - include the following, but are not limited to:

 Staying up late  Disrespect  Swearing  Failure to do chores

26 (Rev. 11/19/15) ______(initial) Discipline includes, but is not limited to:  Verbal warning  Writing 25-100 Character Qualities (CQ’s)  Walking on the basketball court not to exceed 2 hour intervals  Additional chores  Grits/oatmeal for one meal during the day  Loss of privileges (varies)

Major Infractions: - include the following, but are not limited to:

 Violent / aggressive behavior  Direct confrontation with staff or student  Stealing  Any type of substance abuse  Running away  Intimidation of fellow students  Non-compliant behavior

Discipline includes, but is not limited to:

 Physical training (PT)  1 day on basketball court  Loss of pass  Loss of privileges  Discipline crew (Group 2)  Program extension

Physical training will consist of but is not limited to: push-ups, sit-ups, jumping jacks, running, jogging, etc., for ½ hour to 1 hour intervals, not to exceed 1 hour. Failure to perform physical training will result in but is not limited to the following: sitting on the court daily, grits for one meal every day, loss of privileges, wearing jumpsuit every day, no phone calls, loss of time in program, etc. Physical training will NOT consist of: swimming or being in any kind of water, inflicting any physical harm, and / or being in any real danger. CQ requirements – write out definition and memorize attached scriptures. If student is given additional CQ’s over 100, it will result in being placed on Discipline Crew (Group 2). Alternative disciplines will be given for students with more than 100 CQ’s. Continued disciplinary action may result in the Director notifying your probation officer (if applicable). Theft, verbal threats and / or assault may result in a student being arrested by our local law enforcement agency. Students are NEVER allowed to argue or plea for themselves or other students concerning discipline. All disciplines will be documented on discipline reports and filed in their individual student files. The discipline of a student shall not benefit the staff member personally in any manner.

Discipline Crew (Group 2) 27 (Rev. 11/19/15) ______(initial)

 Major infractions and / or continued defiance with program rules and / or schedule will result in student being placed in Group 2.  Requires student to wear a green tee shirt during waking hours.  During recreation time, students will participate in 30 min of physical training.  Free time will be limited to walking or standing assignments.  School time and PSNC/GSNC classes will allow for students to be seated in order to work on their assignments.  No seconds during mealtime.  No talking with other students.  No off-campus recreation trips.  After completing assigned week, each student will be evaluated by staff. Compliance to above rules will result in return to normal program routine (Group 1).  Continued major infractions and / or frequent minor infractions may result in additional days in Group 2 or being placed in Group 3.

Discipline Crew (Group 3)

 Flagrant disregard for program rules and/or schedules, by continually defying staff.  Requires student to wear a jumpsuit during waking hours.  During recreation time, student will participate in 60 minutes of physical training.  Free time will be limited to walking around the basketball court or standing erect while doing assignments.  Students not attending school will be assigned special work details  Students are required to stand erect while eating meals.  No seconds during mealtime.  Liquid refreshments shall be limited to water.  No speaking with other students at any time without special permission form a staff member.  No off-campus recreations trips.  After completing assigned time, student will be evaluated by staff. Compliance to above rules will result in return to normal program routine. (Group 1)  Continued flagrant disregard for program rules and/or schedules may result in additional day in Group 3 with the possibility of loss of pass privileges.

The ultimate discipline for numerous major infractions is discharge of student from the program.

28 (Rev. 11/19/15) ______(initial)

Discipline will NOT include the following: extreme physical training (in excess of 1 hour), loss of more than one phone call, corporal punishment is never implemented, students will not be physically restrained except in the event of a threat to another student, staff or themselves, denial of 8 hours of sleep, denial of medical attention, more than one meal per day of grits or oatmeal, denial of education, etc. (we), pledge to support the Facility in its discipline policy and agree with this approach to discipline. I further understand that a lack of support on my part will result in the termination of this agreement and my child being withdrawn from the Facility.

29 (Rev. 11/19/15) ______(initial) TEEN CHALLENGE VERO BEACH Restraint Policy

 Restraint by force will be used when and if a student is a potential harm to another student, staff or themselves.

 When and how will use of force be applied? When a student becomes combative by vocal or threatening gestures, after being clearly instructed to cease combative behavior.

The staff member on duty will call for back up assistance. If time will not permit, he will proceed to physically bring the combative student under control by using approved procedures, with the goal of restraining the student without causing injury. Hands on procedures are designed to gain control, prevent harm and protect property.

Step one: He always tries to talk a student into submission first Step two: He will always explain what the student did wrong and why corrective actions were taken. Step three: After combative conflicts, the instructor has the right to take pictures of the scene and the student to use as articles in his incident report that will be forwarded up the Chain of Command. Step four: He will file a report of date, time, location, situation, and parties involved. If necessary he will gather additional information in writing from eyewitnesses.

I understand and comply with the Rules, Regulation and Procedures of Teen Challenge of Vero Beach.

I (we), the undersigned, have thoroughly read and do understand this legally binding agreement.

TEEN CHALLENGE VERO BEACH RUNAWAY AGREEMENT 30 (Rev. 11/19/15) ______(initial) Teen Challenge has established a policy regarding students who make the decision to runaway from the facility. It is our hope that every student recognizes her need for Teen Challenge, but in the event a child runs away, the following policy is in effect:

1. The Second Party, parent/legal guardian, has toured the Teen Challenge campus and is aware that it is not a lockdown facility and therefore, the possibility of a student running away does exist.

2. The Second Party recognizes that Teen Challenge accepts children who may have a history of running away and this is one of the rebellion issues that are addressed in the program.

3. The Second Party agrees that Teen Challenge will not be held responsible for the safety of any minor child that runs from the facility.

4. Teen Challenge will report a runaway child to the Local Authorities to facilitate their return. Teen Challenge will not be held responsible for finding a runaway child.

5. Teen Challenge is not responsible to involve itself in any court proceedings resulting from any criminal activity.

6. Students are not necessarily dismissed from the program for running away. We will continue to work with a student an their family to facilitate change as long as progress continues to be made.

7. Running away may result in the student’s program being started over. If a student has been enrolled for less than two months, two months may be added to their program.

8. Any student found talking about running away, regardless of intent, may have two months added to their program.

I have read, understand and agree to the Teen Challenge Runaway Agreement.

______

31 (Rev. 11/19/15) ______(initial) TEEN CHALLENGE YOUR CENTER'S NAME MEDIA RELEASE

There are times during the course of a student's enrollment that they may be interviewed for a testimonial or photographed for publishing purposes. These publishing pieces may be Facebook, Newsletters or other forms of marketing. This media release form will serve as permission to post or publish such information as needed.

I do hereby authorize Teen Challenge and those acting under its permission and on its authority to use and publish for any lawful purpose whatsoever my son’s personal story which I/ he) have/has related to Teen Challenge in whole, or in part, including any photographs of myself/son.

I hereby waive any right that I may have to inspect or approve the finished product or copy that may be used in connection therewith, or the use to which it may be applied.

I hereby release and discharge Teen Challenge, its successors and assigns, and all persons acting under its permission or authority from any liability by virtue of misprint, error, or distortion that may occur unless it can be shown that they and the publication thereof were maliciously caused, produced and published solely for the purpose of subjecting me/my son to conspicuous ridicule, scandal, reproach, scorn, and indignity.

I have read and agree with the above authorization and release, prior to its execution, and that I am fully familiar with the contents thereof.

______

32 (Rev. 11/19/15) ______(initial)

TEEN CHALLENGE SOUTHEAST STUDENT TRANSFER POLICY

The following policy will be followed when a student is declared “dismissed” from one TCSE program, but is potentially "accepted" into another TCSE program:

1) The parent(s)/guardians of the student will be notified of the intent to dismiss and will be made aware of a possible alternative TC center for subsequent enrollment.

2) Parents will notify the Executive Director of the potential new center of their intent to re-enroll their son in that facility. If in the process of a phone interview the student is deemed acceptable, an application will be sent to them, from that center.

3) The parents will comply with the orientation requirements of the accepting center, and the student will begin month one (1) of the minimum fifteen (15) months at the accepting facility upon day of induction.

4) Pick up and transportation of the transferring student to the accepting center will be the responsibility of the parent. TC will not transfer a student from one center to another.

5) Transferring student's admission documents must be complete in order to be received at the transferring center. No student will be admitted into a TCSE center without the required legal documents.

6) It is understood that the prepaid last month’s tuition will remain with the original center until the student completes the program. At the time of completion, the funds will be transferred from the original center to the completing center. If the student does not complete the program, the final month’s tuition will remain with the original center’s account.

33 (Rev. 11/19/15)