Requirements

Fresh Start Resident Agreement

Full Name (First,Middle,Last) *

Present Address *

City *

State *

Zip *

Previous Address *

City *

State *

Zip *

Address of Record *

Date of Birth *

Do you possess an ID/Driver’s License (#/State)? *

Do you possess an Social Security Card? *

Do you possess a pair of WORK BOOTS? *

Closest Family Member(s) Name *

List Family Member(s) Contact # *

List your Present Employer *

City

State

Zip

Employer Supervisor/Contact Person

Emergency Contact/Relationship *

Contact Phone *

Have you ever been convicted of a crime? *

If "yes", please explain

Are you presently in the legal system? *

If "yes", please explain

List any (current) Parole or Probation Officers and contact numbers:

Are you addicted to drugs and/or alcohol? *

If "yes", please explain

Sobriety/Clean Date *

Have you ever been in a Treatment Facility? *

If "yes", please explain

Are you taking any prescription medications? *

If "yes", please list all medications below and reason

ALL MEDICATIONS ARE TO BE KEPT SECURED IN A LOCKED SAFE/BOX. RESIDENTS ARE
INDIVIDUALLY RESPONSIBLE FOR THE PROVISION OF HIS/HER OWN SAFE/BOX.

Have you ever been in a Recovery House, Halfway House or similar facility? *

If "yes", please explain when / where

Do you have a Sponsor? *

If "yes", sponsors name and phone

Please read and “check” to indicate your understanding and agreement:

The Fresh Start Sober Living program requires a $279.00 administrative entry fee. *

Rent is $150.00-$169.00 weekly or $650.00-$732.00 monthly. Rooms are rented by the week/month only. Residents—specifically those in arrears —can make daily monetary payments in any sum/amount. To make a payment, see house manager and ensure receipt is provided. Each week begins on Sunday and ends on Saturday. A rent arrearage can/will result in eviction. Provided a client departs sober and in good standing (i.e., packs and carries his/her own belongings the day he/she departs, washes and places linen back on his/her bed, cleans his/her respective living area, does not return to the premises without permission, etc.) he/she is likely to receive a refund of any overpayment; anything less will result in a pro-rated refund or no refund at all. All refunds are given at the discretion of Fresh Start Sober Living. Departing clients must allow at least (14) days for the processing of any refund. *

Incentive; ; every client that resides in the Fresh Start Sober Living program sober and in good standing—for a period of (26) consecutive weeks—is entitled to a $100.00 refund of their Administration/Entry fee. This is pertinent to the 1st 6 month period only! If the client was sponsored into the Fresh Start Sober Living program it may be suggested and/or necessary to pay back any money initially provided them by the sponsoring entity. The client would then be entitled to the difference, if any, in that which is owed the sponsoring entity and $100.00. *

I realize that the Fresh Start Sober Living program for which I am applying for residency requires complete abstinence from Drugs and/or Alcohol. Any use of Drugs and/or Alcohol is strictly prohibited and will result in immediate eviction from our residence(s). Disruptive and/or Discourteous behavior within our residence(s) or community will not be tolerated and can/will result in eviction from our residence(s). Finally, a client’s inability to maintain employment and pay his/her rent in a timely manner can/will result in eviction from our residence(s). By initialing/signing, I acknowledge agreement to the terms stated, and hereby waive my right(s) to normal due process afforded by local landlord-tenant laws *

I have read all the material on this application, and answered each question honestly. I have a sincere desire to live Clean and/or Sober, and achieve comfortable recovery from alcoholism and/or drug addiction without relapse. Any questions I may have had were answered to my satisfaction. *

Name *

Date *

General House Rules/Requirements/Guidelines:

You are in a Sober Living Program/Environment. Your success and continuance in this program/environment is dependent upon your consistent good behavior and cooperation. Disruptive and/or Discourteous behavior will not be tolerated. Any contact with Illegal Drugs and/or Alcohol and/or violation of any of the following Rules & Guidelines can/will result in eviction. By checking the box, and your digital signature, indicate your understanding and agreement. When in doubt…ASK!

Consumption or possession of beverage alcohol in any form is strictly prohibited. *

Use or possession of illegal drugs in any form is strictly prohibited. *

Use and/or possession of drugs and/or alcohol will result in immediate eviction. If evicted for drugs and/or alcohol the resident agrees to leave the premises immediately and not return for any reason whatsoever, without permission from the House Manager and/or Fresh Start Sober Living. *

Lying, Cheating & Stealing are strictly prohibited. If caught, you will be fined and/or evicted. *

Residents are required to submit to a Drug and Alcohol Screen/Test at any time (24/7) it is requested. A refusal and/or failure to provide an adequate sample will be treated the same as a positive test result. Any attempt to Cheat/Circumvent test will result in a fine/eviction. *

Daily attendance at “12 Step” meetings is strongly encouraged/recommended; the minimum daily attendance requirement is (5) per week. Acceptable meeting attendance is seated & present prior to the Serenity prayer, present for all readings as well as the meeting itself up until and after the Lord ’s Prayer is concluded. ARRIVE EARLY, STAY LATE! MEN WITH MEN, WOMEN WITH WOMEN! *

Residents are required to maintain a Home Group. *

Residents are required to maintain a working relationship with a Sponsor. It is recommended that each Resident be on track to take all “12 Steps” within 6 – 9 months from date of arrival at Fresh Start Sober Living. *

Residents are required to maintain employment. If at any time a client is/becomes unemployed and is capable of working (not injured or sick), he/she must actively seek employment from 8:00 am - 5:00 pm Monday through Friday, and is not permitted at the house during this time. A resident’s employment is prohibited from interfering with their adherence to any of the other terms of this agreement. *

Behavior considered to be a “Conflict of Interest” (i.e., Sponsorship, Employment, Dating, etc.) between Residents is strictly prohibited. NO DATING OR VISITATION BETWEEN RESIDENTS/HOMES OF FRESH START SOBER LIVING WITHOUT PERMISSION from Mr. Gillis. *

Smoking inside any Fresh Start Sober Living home is strictly prohibited. *

Fresh Start Sober Living is NOT (at any time) responsible for a resident’s personal item’s/belonging(s). Residents are responsible for the security and safekeeping of their own personal item’s/belongings and are to pack and carry their item’s/belongings when they depart. If for any reason this does not occur, the Resident may contact - 5 - the House Manager or Fresh Start Sober Living regarding the retrieval/disposition of their personal item’s/belongings. Fresh Start Sober Living will not store personal belongings for more than seventy-two (72) hours. *

Disruptive/Discourteous behavior will not be tolerated and can/will result in eviction. *

Guests of the opposite sex are strictly prohibited from entering any Fresh Start Sober Living home. *

Overnight guests are strictly prohibited. *

Guests are not permitted at the house beyond curfew and are only permitted in the common areas. *

Guests cannot be under the influence or in possession of drugs and/or alcohol. *

New Resident curfew is 6:00pm every night. All others must be in by 10:00 pm Sunday through Thursday and 11:00 pm Friday and Saturday. Residents must adhere to more strict curfews when required (i.e., Parole, Probation, etc.). Failure to return to the house on time can/will result in eviction. *

House quiet time is 10:00pm to 5:00am. Any activity (i.e., Lights, TV, Telephone conversations, etc.) that disturb another residents ability to sleep/rest is prohibited. *

Evicted Residents are required to leave the premises immediately and not return under any circumstances. *

Residents of Fresh Start Sober Living are discouraged from maintaining relationships with those evicted from the Fresh Start Sober Living program. *

House Business Meetings are held weekly at date/time determined by House Manager/Fresh Start Sober Living and are mandatory for every client. An unexcused absence from any House Business Meeting can/will result in a fine, or eviction. *

Overnight/Weekend Passes are to be submitted to the House Manager a minimum of (1) week in advance. Authorization will be granted at the discretion of House Manager and Fresh Start Sober Living. *

Residents are not permitted in any bedroom other than their own without permission from the resident(s) residing in that room; they must also be accompanied by the permitting resident. *

Thermostat is to be adjusted by the House Manager only. *

Washer & Dryer -- Be courteous. Clean dryer lint screen before and after every use and do not leave clothes unattended in the washer/dryer. *

Chores are required to be completed daily. The House Manager is responsible for chore assignment and completion. Failure to complete assigned chore can/will result in fine/eviction. *

A good General Clean-up of all areas inside & outside the home is required at all times. *

Beds are required to be made upon awakening. Respective areas are to be kept neat, clean and picked up at all times. NO SLOBS; YOU CAN/WILL BE FINED! *

Telephone — 15-minute time limit per hour. Be courteous and pass along messages. *

Turn off lights, TV’s, Radio’s, Fans, etc., when not in use. Exterior doors are required to be locked when entering/exiting; no exceptions! *

Residents are required—at all times—to wear appropriate dress in common areas. *

Sleeping in common areas is prohibited. *

Kitchen—Appliances, Counter-tops, Utensils, Dishes, Pots, Pans, etc. will be cleaned and returned to their respective place (immediately) after each use. *

Refrigerator—Mark food/leftovers with Name/Date when initially placed in the refrigerator. *

Fresh Start Sober Living residents are not permitted on any other property within the community without permission from the owner of the property. Additionally, the Fresh Start Sober Living resident must be accompanied by the property owner. *

All prescribed Medication(s)/controlled substances will be retained and dispensed by the House Manager. Any resident caught using/possessing any prescribed Medication/controlled substance unknown to the House Manager or exceeding (1) days dosage of prescribed medication/controlled substances will be evicted! *

Be Accountable/Responsible and Communicate! Accountability, Communication eliminates need for escuses with House Manager *

A violation of any one of the aforementioned Rules & Guidelines can/will result in a fine or eviction. Fines range from as little as $25.00, up to a full $179 (the equivalent of an entry/reentry fee). *

Name *

Date *

New Resident Status

Every “New Resident” entering the Fresh Start Sober Living Program and those residents that violate the conditions of their agreement with Fresh Start Sober Living are placed on “New Resident” status. The Fresh Start Sober Living Program requires strict adherence to the following conditions, and all other Rules, Requirements & Guidelines.

Attend an AA/NA meeting daily & get a meeting sheet signed.
Have a Sponsor (Residents are required to maintain a working relationship with a Sponsor. It is recommended that each Resident be on track to take all “12 Steps” within 6 – 9 months from date of arrival at Fresh Start Sober Living).
Have, attend and participate in a Home Group.
Have and fulfill a Service commitment.
Adhere to a 6:00 pm curfew (If attendance at an 8:00pm “AA/NA” meeting is desired, you may leave at 7:15pm and return no later than 9:45pm and must attend with another Fresh Start Sober Living resident).
Be employed and/or have satisfied all financial obligations.
New Resident status applies to everyone for their first 30 days (minimum).
Residents can/will remain on ‘New Resident’ status until all conditions of their agreement with Fresh Start Sober Living are met/satisfied. If at any time a resident violates the conditions of their agreement with Fresh Start Sober Living, he/she will remain on, or immediately be placed back on “New Resident” status.

To be removed from/remain off of “New Resident” status, you must:

Satisfy all conditions of your agreement with Fresh Start Sober Living and receive a unanimous vote of confidence from other residents (peers).

Residents are encouraged to become thoroughly familiar with the Rules Requirements & Guidelines and conditions of your agreement with Fresh Start Sober Living. Ignorance is not an excuse!

Name *

Date *

Drug Screen/Test

I understand that I can be tested for Drugs and/or Alcohol at any time, for any reason, per my agreement with Fresh Start Sober Living. I am aware and have full knowledge that the person(s) administering the test(s) are my peers and not medical personnel. I am also aware that if I test positive, refuse compliance or attempt to cheat/circumvent the test in any way, I will be evicted from the Fresh Start Sober Living program and required to leave the premises immediately. My signature below indicates my understanding and consent.

Name *

Date *