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  • G.A.P. HOUSE MINISTRIES, INC.Pre- Application

  • "Bridging the GAP to Recovery"
    265 Hunter Estates Dr
    Waynesville Ga 31566
    Telephone: (912) 462-4673(HOPE)
    Fax: (912) 778-3073
    Email: gaphousenministries@gmail.com
    Website: www.gaphousenministries.org

  • 2 Corinthians 5:17-21
    Therefore, if anyone is in Christ, he is a new creation; old things have passed away; behold, all things have become new. Now all things are of God, who had reconciled us to Himself through Jesus Christ, and has given us the ministry of reconciliation, that is, that God was in Christ reconciling the world to herself not imputing their trespasses to them and has committed to us the word of reconciliation.
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  • THE VISION

  • Love your neighbor as yourself. Matthew 22:39
  • To serve everyone with Christ-like compassion, respect, and guidance. To address the needs of residents, to support people in recovery from substance use disorders by improving their access to quality recovery residences through standards, support services, placement, education, research, and advocacy. Recovery residences are important assets within a community and among recovery-oriented systems of services and assisting them in the development of Godly character.
  • THE MISSION

  • To be a beacon of light, hope and compassion during the storms of life. To provide competent drug education and rehabilitation resources. To meet the needs of the addicts and their families throughout our community. To glorify God and further His kingdom by setting the captives free through the love, mercy, and grace of our lord Jesus Christ.
  • At G.A.P. House Ministries, Inc., we guide our residents into a meaningful restorative relationship with Jesus Christ. Our mission is to ease our residents' journey and walk beside them as they leave their old lives behind. This includes releasing the guilt, shame, hurt and secrets of their past. We watch as they transition into amazing new sober lives filled with hope and purpose.
  • HISTORY

  • Southeast Ga. Mothers Against Methamphetamine (SEGA MAMA) a chapter of the national Mothers Against Methamphetamine (MAMA), was founded in 2004 after my youngest child became addicted to Crystal Methamphetamine. Our lives spiraled out of control and the consequences of his addiction were very costly to our family in every way possible. Our next task was to get him into rehab which was no easy task. It was during this extremely hard time in our lives that God birth a ministry to help others like me, and our family who are hurting and needing direction. After four years of providing drug education and awareness in many communities throughout the Southeast Georgia district 2008 God birthed a much-needed ministry. The G.A.P. House Ministries, Inc. was the first rehabilitation program in Brantley County. The G.A.P. House Ministries, Inc. began providing referrals, counseling and long-term therapeutic treatment for women and families.
  • - Regina Hunter
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  • STATEMENT OF FAITH

  • The core beliefs and truths held by the G.A.P. House Ministries; Inc are illustrated in our
    statement of faith:
  • 1. We believe in one God, eternally existent as God the Father, God the Son, and God the Holy
    Spirit.
  • 2. We believe that the Bible, composed of the Old and New Testaments, is God's inspired and
    infallible Word, and is the supreme standard and final authority for all conduct, faith, and
    doctrine.
  • 3. We believe in the deity of the Lord Jesus Christ, in His virgin birth, in His sinless life, in His
    miracles, in His vicarious and atoning death, in His bodily resurrection, in His ascension to the
    right hand of the Father, and in His personal return in power and glory.
  • 4. We believe that man was created in the image of God, but by willful transgression became
    sinful and is justly under the condemnation and wrath of Almighty God.
  • 5.We believe that there will be a resurrection of the just and the unjust; the just, having been
    redeemed by shed blood of the Lord Jesus Christ, to be with Him throughout eternity in glory;
    the unjust, having died impenitent and unreconciled to God, eternally separated from God.
  • 6. We believe that all believers are called to obey not only the first great commandment, to love
    God with all our heart, soul, mind, and strength, but also the second great commandment of our
    Lord "You shall love your neighbor as yourself."
  • 7. We believe that ministry to "the least of these" (Matt 25:40) in the name of Christ is
    commanded for all the Christians and should be the basis of our purpose statement.
  • 8. We believe as the Bible defines marriage as a union between one man and one woman.
    (Genesis 2:24). Jesus Christ upholds this definition of marriage in Matthew 19:5, as does the
    Apostle Paul in Ephesians 5:31. All sexual activity which takes place outside of this context is
    treated as sinful, what Jesus calls 'sexual immorality' in Mark 7:21.
  • G.A.P. HOUSE MINISTRIES, INC.

  • G-God
    A- Answers
    P - Prayers
  • G-God
    A- Always
    P- Provides.
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  • THE PROGRAM

  • G.A.P. House Ministries, Inc. is a therapeutic living program that is composed of a 4-phase process in which the individual will have the opportunity to become connected with God through Jesus Christ. We believe that after our residents gain an independent relationship with God, through Jesus Christ, and gain knowledge of how to work the twelve steps in daily life this will create long term sobriety. We believe that Jesus Christ is the most important part of finding the whole person. As addicts and alcoholics, we need to be healed in mind, body, and spirit. We help our residents in searching for every possible avenue to find spirituality.
  • Many of our residents come to us from home, referrals from inpatient care facilities, and/or judicial systems. We report to those institutions that require monthly reports.
  • We offer support groups, therapy groups, and individual counseling with pastoral counselors, resident counselors and addiction counselors.
  • G.A.P House Ministries, Inc. combines 12-step meetings, WRAP Classes (Wellness Recovery Action Plans), Parenting God's Way, spiritual mentors, Grief Class, Domestic Violence, Bible studies and church so that our residents have every opportunity to find the most valuable component that is needed in their recovery journey (a relationship with Jesus Christ). 12-step recovery meetings offer wisdom, experience, strength, and hope for the suffering resident. Through these combined efforts we believe every resident has the chance to succeed. We work hard to provide a positive and uplifting experience for our residents.
  • We teach life skills and provide recovery curriculum that focuses on the dysfunctional family and family dynamics. We offer classes on parenting, nutrition, the concept of the disease of addiction, reality-based therapy groups (where various topics are discussed), trigger identification, risk factors and behaviors, identifying character defects, relapse prevention, anger management, healing is a choice, boundaries, and childhood trauma to see how it is connected to current life. We incorporate morning meditation and prayer. Meeting life on life's terms and becoming a responsible adult is challenging at first, but it is necessary to grow in recovery.
  • Spirituality plays a huge role in gaining ground against disease. To connect with God, you must first surrender. Absolute surrender includes a radical change in behavior and the person's belief system. One must admit powerlessness against this disease and adopt the belief system that there is One who can help, and His name is Jesus Christ; one must be willing to turn all your cares over to Him daily to remain in permanent recovery. Healing will follow absolute surrender. Through spiritual maturity we learn to "let go and let God".
  • G.A.P. House Ministries, Inc. its volunteers and staff comply with applicable Federal civil rights laws and do not discriminate based on race, color, national origin, age, disability, or sex. G.A.P. House Ministries, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
  • To Whom It May Concern:
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  • Thank you for your inquiry about G.A.P House Ministries, Inc. Enclosed is the application you requested. You must return the application for evaluation.
  • Please understand that due to our limited resources, we cannot accept all applicants. We do not always have a bed available. We will, however, be willing to make referrals if the waiting period is longer than you desire to wait, or in the event your application is not accepted at this time.
  • The G.A.P House Ministries, Inc. staff are pleased to know that you have recognized that your life is out of control and that you want to change. We are honored that you are considering G.A.P. House Ministries, Inc. as a resource to help you with this endeavor. Today, there are many people like you who are living productive lives because of choosing to live in recovery.
  • It is our desire that you fully understand the G.A. P. House Ministries, Inc. program prior to enrollment so you will be certain you are entering the right program for your specific needs.
  • G.A.P. House Ministries, Inc.is based upon the fact that man's basic need is a relationship with God, through Jesus Christ. People use drugs and alcohol in the attempt to fill the void in their lives that only Jesus Christ can fill. When Jesus is genuinely received as Lord and Savior of one's life, a total transformation will follow. By that, we mean the person's life will radically change. The Lord Jesus Christ is not interested in whether you go to church or have "said a prayer," He must be Lord of all your life. In fact, He will deal with your attitude and the motives of your heart.
  • REMEMBER, G.A.P. House Ministries, Inc.is governed by BIBLICAL love. It is not always an easy, "soft" love. At times, this love is demonstrated by staff members confronting you with things you do not want to hear. They are willing to risk temporary rejection because it is for your ultimate good. Their goal is not to pacify you nor try to make you feel happy; rather, it is to teach you how to live and walk with God. The Bible teaches us that a happy, blessed life is a by-product of a right relationship with God.
  • Upon entering G.A.P. House Ministries, Inc., you will soon discover it is not the perfect place, neither is it full of perfect, "easy-to-get-along-with" people. Most of them have many problems, bad habits and defense mechanisms as you do. However, there is no better place to develop inter-personal skills and grow in patience and love. May God bless you and give you wisdom on your decision!
  • I look forward to being a part of your life transformation!
  • Regina Hunter
    Executive Director
    D.A.T. Treatment Specialist, CIT, C.A. R. E.S, Biblical Counselor
    G.A.P. House Ministries, Inc.
    Telephone# 912-462 HOPE (4673)
    Fax# 912-778-3073
    Gaphouseministries@gmail.com
    www.gaphouseministries.org
    "Bridging the gap to recovery
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  • PRE-ADMISSION

  • Thank you for taking this important step towards your future and the life God has planned for you. We are honored to have the opportunity to serve you. G.A.P. House Ministries, Inc. and facilities are designed to create environments that nurture healthy relationships with God, self, and others. G.A.P. House Ministries, Inc. is a Christ-centered, 12 bed, 12-24-month therapeutic living facility for women who are seeking recovery from chemical dependency and other life- controlling problems. G.A.P. House Ministries, Inc. provides a full continuum of care for residents and leadership training opportunities for graduates. The focus is on applied Christianity for the healing of the total person, recovery from life controlling problems and preparation for successful living. To assist you in the admissions process, we have provided the steps to be considered for admission, the requirements for admission, a list of what you can bring and some information about what to expect when you get here.
  • STEPS TO TAKE: CANDIDATES FOR ADMISSION ARE RESPONSIBLE FOR:

  • Thoroughly complete this application and then email, mail, or fax it to:
    Intake Coordinator
    G.A.P. House Ministries, Inc. email: gaphouseministries@gmail.com
    265 Hunter Estates Dr. fax: 912-778-3073
    Waynesville, GA. 31566
  • • Contacting the Intake Coordinator with questions regarding your intake status.
    • Resolving any issues which may interrupt your 12-24-month commitment.
    • Signing and dating this application in the space provided.
    • Arranging a time to speak with the Intake Coordinator for an interview.
  • REQUIREMENTS FOR ADMISSION: CANDIDATES FOR ADMISSION MUST:

  • • Be female, age 18 or older, requesting admission themselves and sincerely willing to change.
    • Agree to abide by all guidelines, fully participate in all aspects of the Christian Program and refrain from any activity staff deems contrary to recovery or Christian growth.
    • Be fully detoxified and 5 days away from their last use of drugs or alcohol of any kind.
    • Be willing and able to commit to an uninterrupted 12-24-month resident program.
    • Be physically able to perform work assignments such as housekeeping, kitchen, laundry, and clerical.
    • If on medication, residents will need to have a 90-day supply to be accepted for admission.
    • Be mentally stable and capable of functioning in a therapeutic community environment with classroom and group activities.
    • Be willing to refrain from the pursuit of romantic relationships while in the program.
    • Must pay an Intake Fee of $200.00
  • WHAT RESIDENT MAY HAVE: Residents are only allowed to have items staff considers conducive to recovery and to Christian growth. They are not allowed to have more than $30.00 in their possession at any time and should plan for off-premises safe storage of cash and valuables before arrival. Must have an intake fee of $200.00 plus first month's rent of $900.00. All fees must be paid up to date, or no certificate will be given at the time of completion. Residents may arrange for supporters to send money periodically for miscellaneous items,

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  • snacks, etc. Staff may monitor spending or other stewardship concerns when deemed
    appropriate.
  • ITEMS YOU NEED TO BRING (MAY NOT EXCEED THE FOLLOWING):

  • Please bring
    seasonally appropriate attire, all shorts must be knee length, 10-Casual outfits, 5 - Dress outfits,
    2- Outfits for workout (t-shirts and sweats/jeans/walking shorts, spandex), 10 - Pair of
    underwear, 2 - Bras and 1- slip, 10 - Pair of socks and 2-Pair hose/knee highs, 6 - pairs of shoes,
    2- Nightwear outfits, 1-Robe, 3 - Jackets/sweaters, 2 - Heavy coats including accessories.
    Toothbrush, toothpaste, shampoo, deodorant, hairspray, sanitary napkins, tampons, Alarm clock,
    Bible, book bag, notebooks, pens. Approved unopened over the counter medications. Residents
    should bring as many of these items as possible but not exceed limits. Excess items will not be
    stored. You will be allowed to wash your clothes once a week during the weekends. At the end of
    your first month, you may "swap out" some of your belongings if your family is willing to bring
    you different clothes.
  • Items you may NOT bring:

  • Do not bring skimpy, revealing clothing or clothing with sexual or
    slanderous advertisement on it. You will not be allowed to wear these items. No energy pills or
    drinks. Residents are not allowed to have cell phones, paging devices, or non-approved
    medications. No mouth wash, nail polish remover, no electronics (this includes no sex toys, no
    musical instruments, no electronic cigarettes). Please do not bring valuable jewelry. No books or
    magazines, no CD's, or DVDs, no vapes, inappropriate materials, or pictures.
  • ITEMS YOU MUST BRING:

  • Must have an intake fee of $200.00 plus the first month's rent of
    $900 dollars. All fees must be paid up to date or no certificate will be given at completion time,
    two forms of ID (one with picture plus a social security card or birth certificate), 90-day
    prescribed medication. No narcotics and no benzos are allowed, unless approved by staff.

  • What to Expect:

  • At G.A.P. House Ministries, Inc., you can expect to find a safe environment in
    which your relationship with God can grow. To accomplish this, we have developed these basic
    guidelines:
    • Visitors are not permitted during the first 30 days of the program. Once the first 30 days are
      completed, visitors must be approved by the Director before they can visit.
    • You will not receive phone calls and may not make outgoing calls for the first 30 days.
  • We believe that the deepest need of anyone is a relationship with Christ and the beginning road
    to recovery. We celebrate your step of courageous faith. Please print your name and sign below
    once you have read and understand this application.
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  • PRE-APPLICATION FOR ADMISSION

  • Section 1Personal Information

  • DOB:
     - -
    2 digit month, 2 digit day, 4 digit year
  • In the past 30 days where have you lived? Please choose one:
  • Format: (000) 000-0000.
  • Do you receive food stamps?
  • Please check one:
  • Did you have help filling out this application?
  • In Case of Emergency Notify:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
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  • Referred to G.A.P. by:
  • Format: (000) 000-0000.
  • Section 2

  • Personal History of your Parents:

  • Is your mother living?
  • Is your father living?
  • Are your living parents?
  • Were you adopted?
  • Brother/Sister:
  • Format: (000) 000-0000.
  • Brother/Sister:
  • Format: (000) 000-0000.
  • Brother/Sister:
  • Format: (000) 000-0000.
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  • Brother/Sister:

  • Format: (000) 000-0000.
  • Brother/Sister:

  • Format: (000) 000-0000.
  • Section 3

  • Personal History:

  • Are you?
  • Did you ever participate in homosexual acts?
  • Do you consider yourself homosexual:
  • Your Spouse/s, Boyfriends?

  • Format: (000) 000-0000.
  • Do you live together?
  • Do you have kids together?
  • Do you have custody of your children?
  • Are you court ordered to pay child support?
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  • Name, gender, and ages of your children:
  • Section 4

  • Education:
  • Did you graduate? Yes No
  • If not, do you have a GED? Yes No
  • Section 5

  • Medical History:
  • What is your physical health? Good Fair Poor
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  • Are you HIV Positive?
  • Do you have Hepatitis:
  • Have you been treated?
  • Do you have any STDs?
  • Section 6

  • Drug/Alcohol/Tobacco History:
  • Please check all that apply:
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  • Section 7

  • Rehabilitation Centers/Hospitals:
  • Dates
  • Section 8

  • Mental Health:
  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Section 9

  • Employment History:
  • Format: (000) 000-0000.
  • Date: From:
     - -
    2 digit month, 2 digit day, 4 digit year
  • to:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Section 10

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  • Section 11

  • Church Member?
  • Format: (000) 000-0000.
  • Do you believe in God?
  • Are you Born Again?
  • Section 12

  • G.A.P. House Ministries, Inc. is not a medical or psychiatric facility. Therefore, prospective clients must be medically, as well as psychiatrically, cleared up prior to admission. Requested medical information is vitally important and is required before a decision can be made as to the appropriateness of our facility for prospective clients. If mental health evaluation/documentation is requested, that also must be received before a final decision can be made on placement in our program. If, after admission, it is noted that the client is inappropriate due to medical or psychiatric reasons about which we were uninformed prior, G.A.P. House Ministries, Inc. reserves the right to refer the client to another facility or back to the referring agency.
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
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  • G.A.P. HOUSE MINISTRIES, INC.

  • Welcome to G.A.P. House Ministries, Inc. This is a therapeutic sober living/transition home for women. All residents are expected to have a true desire to live clean and sober. Drugs and alcohol are not permitted, and anyone found using will be dismissed immediately. While in this program, residents will have the opportunity to become connected with God through Jesus Christ.
  • Our program is a 12-24-month program. All residents must want to be sober, follow the house rules and be physically able to work. The rent is $900.00 a month and is due every 5th of the month. If you get more than 30 days behind on your rent, you will be asked to leave.

  • G.A.P. House Ministries, Inc. combines 12-step meetings, sponsors, spiritual mentors, Bible studies and church so that our residents have every opportunity to find the most valuable part that is needed in their recovery journey (a relationship with Jesus Christ). 12-step recovery meetings offer wisdom, strength, and hope to the suffering addict. Through these combined efforts, we believe every resident has the best opportunity to succeed. We work hard to provide a positive and uplifting experience for our residents.
  • Everyone is expected to be self-motivated and willing to follow the program's rules and regulations. In phase 4, if you can work and once your employment is secured, you are expected to attend at least one processing group, two 12-step groups, and two church services per week. As you move into the different phases in your program, you are required to work on your program and not become complacent or break program rules. We use progressive discipline in our facility, which means we administer fair and consistent discipline for unsatisfactory conduct. You are expected to be a good steward of what God has given, and that means keeping the grounds neat as well. House meetings are mandatory.
  • If you leave G.A.P. House Ministries, Inc., you have to pack your things immediately. If you leave without your things they will be placed in donations after 48 hours. You will not be allowed back in the house once you leave. Please understand, the money in your account will be paid toward any arrears, transit, or fees/dues you might have incurred during your stay in this program. You will receive the balance after agreed upon requirements have been met. You must leave a forwarding address and contact information. You are not allowed to have cell phones or personal automobiles while a resident of the G.A.P. House Ministries, Inc. program. G.A.P. House Ministries, Inc., and staff will not be held responsible for any accident, illness or injury that may occur while living here. You are responsible for your own medical bills.
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
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  • RESIDENTS' RIGHTS AND RESPONSIBLITIES POLICY

  • Residents will be informed of rights and responsibilities upon admission into the program. This form will be signed and dated by the resident, and a copy will be placed in the resident's folder.
    Resident's rights are to ensure therapeutic experience for each resident:
    • You do have the right to adequate care so that you may regain your health and return home as soon as possible.
    • You do have the right to privacy and the right to move about freely in the least restrictive atmosphere that your environment and safety permit.
    • You do have the right to own your own clothes and personal possessions. This may be restricted if your clothes and/or possessions are determined to be dangerous or inappropriate.
    • You do have the right to prompt and adequate medical care for your physical ailments. G.A.P. House Ministries, Inc. does not provide for medical expenses incurred.
    • You do have the right to make limited phone calls after the first probation period has expired.
    • You do have the right to send and receive mail; however, you must turn your outgoing mail into staff unsealed. Staff reserve the right to read all incoming and outgoing mail to determine whether we deem your mail inappropriate or not and what is best for your recovery will be held at the staff's discretion.
    • You do have the right to receive financial account statements and receipts to verify your financial status.
    • You do have the right to secure an attorney to help with legal complaints or problems. This will be at your expense since G.A.P. House Ministries, Inc. does not provide for legal expenses incurred.
    • You do have the right to attend scheduled activities, Bible studies, and church services.
    • You do have the right to vote by absentee ballot.
    • You do have the right to keep visitors away from home during regularly scheduled visiting hours as designated by G.A.P. House Ministries, Inc. Your attorney, physician, and other professionals can visit you at any reasonable time.
    • You do have the right to appeal if you do not agree with decisions made by the staff.
    • You have the right to Confidentiality as specified by Federal and State Laws.
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  • Responsibilities are as follows:

    • Be honest about matters that relate to you as a resident.
    • Follow directions and advice from the staff members.
    • Know the staff members who care for you and take an active part in Processing Meetings.
    • Report changes in your condition.
    • Be considerate and respectful of the rights of both fellow residents and staff members.
    • Honor the confidentiality and privacy of other residents.
    • Avoid making unreasonable demands.
    • Work your own recovery "Stay in your own lane".
    • Keep appointments and cooperate with staff members.
    • Relate incidents that can be harmful to you and/or your fellow residents. This includes physical, emotional, or psychological harm.
    • Abstain from the use of alcohol and other mood-altering chemicals. Take prescription medication only as approved by G.A.P. House Ministries, Inc.
    • Adhere to the above guidelines. Not doing so will result in consequences ranging from denial of privileges to dismissal from G.A.P. House Ministries, Inc. The consequences for inappropriate behavior are based on the severity of the behavior and the number of offenses.
    • Please return all forms signed to G.A.P. House Ministries Inc. for review and a member of the staff will contact you within 24 hours of receiving your application. If you have any questions, please call the office on 912-462-4673. Make sure you add a phone number where you can be reached for your application, questions and phone interview. Thank you for the opportunity to help you along your journey of recovery. May God bless you.
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  • G.A.P. House Ministries, Inc.
    265 Hunter Estates Dr, Waynesville, GA 31566
    Phone: (912) 462-HOPE (4673) Fax: (912) 778-3073
    gaphousenministries@gmail.com
    www.gaphousenministries.org

  • Authorization to Obtain and Release

  • I hereby request and authorize:
    Representative: Regina Hunter, Director
    G.A.P. House Ministries, Inc.
    265 Hunter Estates Dr.,
    Waynesville, GA 31566
  • To provide to:
  • The following type(s) of information from my records (and specific portions thereof):
    For the purpose of: Therapeutic Treatment for Residential Living
  • I understand that the Federal Privacy Rule (“HIPPA”) does not protect the privacy of information if re- disclosed and therefore request that all information obtained from this person or agency be held strictly confidential and not be further released by the recipient. I further understand that eligibility for benefits, treatment or payment is not conditioned upon my provision of this authorization. I intend this document to be a valid authorization conforming to all requirements of the Privacy Rule and understand that my authorization will remain in effect for: (PLEASE CHECK ONE)
  • X The period necessary to complete all transactions on matters related to services provided to me. I understand that unless otherwise limited by state or federal regulation, and except to the extent that action has been taken based upon it, I may withdraw this authorization at any time.
  • USE THIS SPACE ONLY IF AUTHORIZATION IS WITHDRAWN
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  • G.A.P.

    G.A.P. House Ministries, Inc.
    265 Hunter Estates Dr, Waynesville, GA 31566
    Phone: (912) 462-HOPE (4673) Fax: (912)778-3073
    gaphouseministries@gmail.com
    www.gaphouseministries.org

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  • RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY ASSESSMENT

  • G.A.P. House Ministries, Inc.

  • IN CONSIDERATION of being permitted to participate in any way in any event ("Activity") at any time during the current calendar year I, for myself, my personal representatives, assign, heirs, and next of kin:
  • 1. ACKNOWLEDGE, agree and represent that I understand the nature of the Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if, at any time, I believe the conditions to be unsafe, I will immediately discontinue further participation in the Activity.
  • 2. I FULLY UNDERSTAND that: (a) THIS ACTIVITY INVOLVES RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("Risk"); (b) these risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the conditions in which the Activity takes place, or THE NEGLIGENCE OF THE "RESEASEES" NAMES BELOW; there may be OTHER RISKS or SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS AND DAMAGES I incur as a result of my participation
  • 3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the sanctioning organization(s), Of G.A.P House Ministries, Inc., their administrators, directors, agents, officers, members, volunteers, and employees, other participants, officials, rescue personnel, sponsors, advertisers, fees, owners and lessees of Premises: 192 Landing Lane, Waynesville, Ga. 31566, 265 Hunter Estates Waynesville Ga. 31566, 232 Piper Lane, Waynesville, Ga. 31566, 8122 Browntown Rd, Waynesville, Ga. 31566 which the Activity is conducted, (each of the forgoing shall be considered one of the RELEASEES herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, of anyone on my LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL IDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim.
  • I ACKNOWLEDGE THAT I AM AGE 18 OR OLDER, HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE SIGNED IT FREELY AND WITHOUT AN INDUCEMENT OR ASSURANCE OF ANY NATURE, AND I INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
  • Format: (000) 000-0000.
  • DATE:
     - -
    2 digit month, 2 digit day, 4 digit year
  • 20 | Page
    Revised 6/9/25
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