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Name *
Name
Address
Address
Phone
Phone
Birthday
Birthday
Do You Have Children?
Do You Have Pending Legal Matters?
Do You Attend Church?
Agreement And Signature
A $3500.00 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. I understand that The Ark is a religious Biblically based organization, a ministry of Calvary Chapel whidbey island. The purpose is to process new creatures in Christ into 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, integrating back into the world while maintaining their relationship with Jesus Christ.
By checking this box and entering your name and the date, you are stating your understanding of the above paragraphs. This is the electronic equivelant of your signature. * *
Name *
Name
Date *
Date
References
Name 1
Name 1
Phone 1
Phone 1
Name 2
Name 2
Phone 2
Phone 2