1. Bethel Colony is a faith ministry which depends solely on donations.
2. Bethel Colony of Mercy is a Christian renewal center designed to help men who are truly ready to make a change in their life. Victory in living through Jesus Christ and the truth of the Bible is taught here. This is accomplished through classroom teaching, audio & video tapes, one-on-one counseling, homework assignments, worship services and work projects.
I have reviewed the info and willing to consider what Bethel has to offer (required) I Agree
3. The program at Bethel is for
65 consecutive days and we expect you to make a firm commitment to fulfill all 65 days. Is there anything, including finances, that would prevent you from doing this? Yes No
4. Do you smoke?
Do you use smokeless tobacco? Yes No Yes No
We discourage smoking but allow it in designated areas and at specified times only.
Cigarettes only; - vapes, e-cigs, roll your own or any other form of tobacco are not allowed.
You are responsible for your own cigarettes and we will not take responsibility for providing those for you or replacing any that are misplaced.
There is also a $10.00 drug-screening fee when you check in to Bethel. After that, any time you have a visit you will be required to pay a $10.00 fee before you leave on your visit to cover a drug screening upon your return.
A. How would you rate your overall health? Good Fair Poor
B. What is the date of your last hospitalization?
Esplain reason for hospitalization: C. What is the date of your last physical examination?
D. Have you ever had Hepatitis? Yes No
E. Have you ever had TB? Yes No
If yes, when? If yes, you will need a doctor's letter stating you have been cleared and no further signs are evident. F. Have you ever tested positive for HIV? Yes No
If yes, when?
G. Have you ever been diagnosed with schizophrenia and/or personality disorder?
If so, what was the diagnosis? H. Please check any of the following you have been diagnosed with:
Diabetes Emphysema Heart Problems High Blood Pressure Hypoglycemia
ANY sexually transmitted diseases? Yes No
If yes to STD's, which one(s)?
I. You must have a TB and HIV test as well as a pregnancy test done prior to being called to come in Bethel. (Flu Shot required from October through March, you will need to have a flu shot with documentation. ) These test results may take up to a couple of weeks. You will not be placed on the active waiting list until we receive st least one of the test results.
Fax results to: Office Manager, (828)754-5370, attn: Women's Campus, email to firstname.lastname@example.org or mail to: Bethel Colony of Mercy 1181 Camp Carolwood Road Lenoir, NC 28645
You need to take care of any dental, vision or any other medical issues before entering this program. We are not a medical facility nor do we have available the transportation to take care of non-emergency medical needs.
Absolutely no medications on the DEA's list of scheduled medications will be allowed, such as; xanax (alprazolam), klonopin (clonazepam), Suboxone, etc. (THIS LIST IS NOT ALL INCLUSIVE)
J. If you have any open woulds of infections, they must be treated and healed before you enter Bethel Colony. This includes injection sites for IV Drug users. (b)You must be free from all infectious diseases, such as Staph, MRSA, and Strep. (Herpes must be dormant).
6. Is there anything else you can think of that would help us to minister to you?
7. You are required to have someone bring you to our facility. (You cannot drive yourself) Who will be transporting you to and from our location?
8. For a
of what you will need to bring and what is not allowed click here. These are the
items you will need
- Bring work and dress clothes Some that are not allowed are: no words or photos with drugs, tobacco, alcohol, or anything contrary to a Christian lifestyle; no tight fitting pants without a long top covering them; no low cut tops. No spaghetti straps; no short-shorts.
- Bring your own washcloths, towels, and pillows. (mark your name on them). Bed linens are provided.
- Bring your own personal toiletry items (nothing with alcohol, ie; mouthwash, colognes, or aerosols)
- Bring a cloth mesh 36 x 24 laundry bag. (Can be purchased at Wal-Mart.)
- Vitamins which are new with the seal unbroken.
- Napkins, toilet tissue, paper towels, facial tissues, laundry detergent, and feminine hygiene products.
- Bring a Bible if you have one.
These are the items that are NOT allowed:
- NO BODY PIERCING RINGS OR STUDS WORN ANYWHERE ON YOUR BODY!!
- No audio or video apparatus: CDs, DVDs, MP3, IPods, Video Games, etc.
- No over the counter medications.
- No caffeinated drinks, coffee, or pills.
- No provocative clothing either daily wear or sleep wear.
- NO cell phones.
9. We are offering to help you overcome your bondage, however, this must be on our terms. Are you willing? Yes No Do you still want to come? Yes No
10. If you have any questions, please email Bethel at email@example.com and we will respond quickly. Please keep in contact with us throughout the application process.
I have answered all of the above questions on this application honestly and to the best of my ability. (required) Yes
I HAVE READ THIS ENTIRE APPLICATION AND AGREE TO FOLLOW ALL THE GUIDELINES SET IN PLACE BY BETHEL COLONY OF MERCY. BY SIGNING, I PROCLAIM I HAVE ANSWERED HONESTLY TO THE BEST OF MY ABILITY. I UNDERSTAND ANY ANSWERS GIVEN WHICH ARE FOUND TO BE INACCURATE MAY BE REASON FOR ME TO BE ASED TO LEAVE THE FACILITY.
**Please read the following notes of interest before submitting your completed application.**
I have read and will comply with the above regulations. (required) Yes
IF YOU HAVE ANY QUESTIONS REGARDING THIS APPLICATION PLEASE CALL
OUR OFFICE AT 828-754-3781. Within 72 hours of receiving your application someone from our office will call you to complete your application process. WHEN WE CALL WE MUST SPEAK TO THE PERSON APPLYING. In the case that we have not talked to you within the 72 hours please contact our office to complete your application process.
Please make sure that you have filled in the contact phone numbers where
you can be reached.
After completing and submitting your application we will need the results of two blood tests (HIV and TB) and the $250.00 Entry Fee before you will be called to come to Bethel.
Once entered into the program this Entry Fee is non-refundable.
There are now two ways to pay your Entry Fee:
1. Mail a money order to Bethel Colony of Mercy, 1181 Camp Carolwood Road, Lenoir, NC 28645. If you are paying by money order please make sure you write the applicant's name on the "For" line. 2. Pay your Entry Fee online. There is an additional non-refundable fee for the online payment of your Entry Fee.