Doulos Online Submission Form


Doulos Application
Thank you for your interest in the Doulos Program. Before you complete our application we would like to introduce you to the vision and mission of the Doulos Program.

Our Mission and Vision:
The vision of the Doulos program is to provide discipleship and nurture servant leadership as one learns what it truly means to be God’s “doulos”, no longer a slave to sin but now a slave to christ. We desire to see each teen walking with Christ, firmly rooted, being built up in Him and established in their faith, and overflowing with gratitude.
Mission:
-Emphasis placed on the teaching and studying of God’s Word (daily individual and group Bible studies)
-Application of God’s Word: Serving others in response to God’s love in the ministry at Head Waters Lodge. This includes serving in the kitchen, serving the staff and campers, maintaining a clean facility, landscaping, serving other in the community, and more…

Note from Program Director:
We are so excited that you have inquired to be a part of the Doulos program! Before you continue on with this application, please step away from the screen and pray. Pray for the Lord to direct you and speak to you concerning your involvement in the Doulos program this summer. As you now look over this application, please be encouraged to know that we are also praying for you! We desire for God to do a wonderful work in the lives of all that come to the Doulos program this summer.
This year we are offering two and three week sessions. The cost for two weeks is $300 per session and three weeks is $400. After we have received your application with choice of sessions you would like to serve, we will send you a confirmation email and we will contact you by phone. I can’t wait to serve alongside of you!
Christ’s Slave, Bob Kelly

Applicant Information:
Full Name:
	Male Female
Address:
City/State/Zip:
Home Phone:
E-mail:
Alternate Phone:
Date of Birth:
If minor, please list the name of your:	Father Mother Guardian
Name of Individual selected above:
Phone Number of Individual selected above:
Have you gone through the Doulos program before?	yes no
Dates: (if you selected yes above)

Personal Information:
Name of Church/Fellowship you attend:
Pastor & Youth Pastor’s Name:
How would you describe your relationship with your parents?
How do you think they would describe their relationship with you?
Have you been involved with any of the following in the past year?	Alcohol Tobacco Illegal Drugs None
If so, explain:
Have you ever been expelled from school?	yes no
Have you ever served time in a juvenile detention center or jail?	yes no
Have you ever been convicted of a crime?	yes no
If so, explain:

Your Health:
Do you have any physical limitations that might affect your ability to serve in the Doulos Program?
How would you describe your overall health & fitness:	Excellent Good Average Needs Work
Are you presently taking medication prescribed by a doctor?	yes no
If so, write out what medications and what limits it may cause:

Spiritual Life:
Write out your personal testimony of when and how you came to repentance and faith in Jesus Christ. Please write specific details and dates (if you know them)
What impact does the bible have in your life?
How is your relationship/walk with Jesus today? Please describe.

Personal Questions:
Have you ever been to Head Waters Lodge for a camp?
Why do you want to come be apart of Doulos this summer? What do you hope to get out of it?
Apart from Jesus Christ, who has made the biggest impact on your life and why?

Session Dates:
Please select your first and second choices for sessions. We will notify you of your dates of service with your confirmation email and follow-up phone call.
2 Week Sessions: June 13-26, June 27-July 10, July 11-24, July 25-August 7
3 Week Sessions: June 13-July 3, July 25-August 14
First Choice:
Second Choice:

Read Before Signing:
By signing this application to join “The Doulos Program” this summer you are agreeing to abide by the policies and standards of Youth Development Incorporated, (Y.D.I.) If you are unable to abide by these policies, this could result in dismissal without refund or reimbursement. Your signature, and your parent’s authorizes Y.D.I to contact your personal references listed on this application. Also, by signing this, Y.D.I. is not liable for sickness, accident, death, or responsible for transportation or any other expense beyond normal involvement. Your signature acknowledges that you know before you come that “The Doulos Program” may require intense physical activity, including hiking, walking, climbing, and long hours. It also signifies that all the information you gave on this application is accurate and true to the best of your knowledge. And last, your signature (along with your parent’s) gives Y.D.I. the right to use your picture, voice, and testimony in any form for advertising material.
Digital Signature of Applicant:
Date Applicant has signed:
Digital Signature of Parent or Guardian:
Date Parent or Guardian has signed:

Doulos Online Submission Form

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