Transitional Sober Living

This form is for in house use only by SALS Recovery Managers

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* 1. Name of Applicant:

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* 2. Date:

Date

Expectations and Recovery Agreement
Please initial after each question

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* 3. I agree to the rules herein as being created to regain structure, accountability, and responsibility back into my life.

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* 4. I agree to allow Staff to search my property at anytime.

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* 5. I am solely responsible for any personal lost or stolen property, NOT SALS Recovery House.

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* 6. I agree to not use drugs/alcohol while a resident here and to report any use, possession or under-the-influence of any drugs or alcohol on the premises, including my own. Abstinence is required here. I agree to submit to random drug /alcohol tests. I understand that I may be requested to take a spice or bath salts test at a lab. Refusal or failure to submit to and provide a sample for such tests under direct observation will be considered a “dirty test.”

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* 7. I agree to stay med. compliant and inform Staff of any changes in prescriptions. I am completely responsible for my medication time and my medication dose. I understand that Methadone and Suboxone are not allowed at SALS Recovery House .

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* 8. I agree to perform my daily chore assignment(s), make my bed, clean my room, and keep common areas around house clean at all times.

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* 9.
I agree that no visitors, children or people of the opposite sex are allowed on SALS Recovery House property at any time, unless approved by SALS Staff.

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* 10. Overnights are allowed after thirty days with pre-approval from the house manager.

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* 11. I agree to always be appropriate, as verbal, visual or offensive actions towards others are old behaviors and will not be tolerated. Also, no weapons are allowed here. Staff will not hesitate to call the local law enforcement agency for crimes committed here.

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* 12. I agree to find employment that fits within the stucture of SALS Services by filling out a minimum of 10 applications per day.

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* 13. I agree to take part in all house community activites as shown on the house schedule or instructed by staff.

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* 14. Any resident can be asked to take a drug or alcohol test at any time if the house decides. Refusal to take the test is considered a relapse, resulting in expulsion.

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* 15. SALS residents are expected to occupy their time by working, volunteering, or going to school at least 20 hours per week. If you are not, you will be required to fill out applications for work or volunteering (min. of 10/day) or enroll in school. Once this is done, you are welcome to come and go as you please and work any shift job or volunteering you want.

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* 16. New residents have an 11:00 pm curfew and must call to confirm they are in for the evening. Call:__________________________________

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* 17. Pay your cost-of-living expenses on time. Payment is due on Friday evening for the upcoming week. If not paid on time, you will be charged a $20.00 late fee.

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* 18. HOUSE FEES: A NON-REFUNDABLE ORIENTATION FEE OF $200 IS DUE AT THE TIME OF MOVE-IN ALONG WITH THE FIRST WEEKS NON-REFUNDABLE COST-OF-LIVING FEES OF $150. A NON-REFUNDABLE COST-OF-LIVING FEE OF $150 IS DUE WEEKLY AFTER TIME OF MOVE-IN.

SALS House MEMBERSHIP APPLICATION
Ensure the potential applicant has read these sections prior to signing.

MEMBERSHIP APPLICATION IMPORTANT NOTICE: SALS house Sober Living is a recovery home which requires expulsion, without prior notice or refund of deposit and fees, of any member who is found to be: 1) using alcohol or drugs; 2) engaging in disruptive behavior; or 3) in default of payment of weekly membership fee. All resident tenants of SALS house Sober Living are members of our recovery home. You do NOT have renter’s rights or any rights of tenants pursuant to the Wisconsin Property Code, and expressly waive any such rights in exchange for membership privileges.

I have read the above notice and understand that I am applying for membership of SALS house Sober Living as a member of a recovery home. I agree to abide by the responsibilities and requirements of the house and fully subject myself to the rules of the home, which include periodic/random drug testing. A Safe Environment Promise: I understand that I am subject to immediate expulsion from the home if any of the following occur: 1) I use alcohol or drugs (other than prescribed medications); 2) I engage in disruptive behavior (continued patterns of irresponsible behavior are considered disruptive behavior).

By signing below, I certify that the information contained in this application is true. I have read and understand the SALS Sober Living house rules and policies. I understand and accept the above conditions set forth for membership to SALS house Sober Living, and agree to abide by said conditions should I be selected as a member resident.

AGREEMENT:
By signing below, I certify that the information contained in this application is true. I have
read and understand the SALS Sober Living house rules and policies. I understand
and accept the above conditions set forth for membership to SALS House Sober Living, and
agree to abide by said conditions should I be selected as a member resident.

AGREEMENT: By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding. By signing below, I accept the conditions of this agreement.

Question Title

* 1. Name of Applicant:

Question Title

* 2. Date:

Question Title

* 3. I agree to the rules herein as being created to regain structure, accountability, and responsibility back into my life.

Question Title

* 4. I agree to allow Staff to search my property at anytime.

Question Title

* 5. I am solely responsible for any personal lost or stolen property, NOT SALS Recovery House.

Question Title

Question Title

* 7. I agree to stay med. compliant and inform Staff of any changes in prescriptions. I am completely responsible for my medication time and my medication dose. I understand that Methadone and Suboxone are not allowed at SALS Recovery House .

Question Title

* 8. I agree to perform my daily chore assignment(s), make my bed, clean my room, and keep common areas around house clean at all times.

Question Title

* 9. I agree that no visitors, children or people of the opposite sex are allowed on SALS Recovery House property at any time, unless approved by SALS Staff.

Question Title

* 10. Overnights are allowed after thirty days with pre-approval from the house manager.

Question Title

* 11. I agree to always be appropriate, as verbal, visual or offensive actions towards others are old behaviors and will not be tolerated. Also, no weapons are allowed here. Staff will not hesitate to call the local law enforcement agency for crimes committed here.

Question Title

* 12. I agree to find employment that fits within the stucture of SALS Services by filling out a minimum of 10 applications per day.

Question Title

* 13. I agree to take part in all house community activites as shown on the house schedule or instructed by staff.

Question Title

* 14. Any resident can be asked to take a drug or alcohol test at any time if the house decides. Refusal to take the test is considered a relapse, resulting in expulsion.

Question Title

Question Title

* 16. New residents have an 11:00 pm curfew and must call to confirm they are in for the evening. Call:__________________________________

Question Title

* 17. Pay your cost-of-living expenses on time. Payment is due on Friday evening for the upcoming week. If not paid on time, you will be charged a $20.00 late fee.

Question Title

* 18. HOUSE FEES: A NON-REFUNDABLE ORIENTATION FEE OF $200 IS DUE AT THE TIME OF MOVE-IN ALONG WITH THE FIRST WEEKS NON-REFUNDABLE COST-OF-LIVING FEES OF $150. A NON-REFUNDABLE COST-OF-LIVING FEE OF $150 IS DUE WEEKLY AFTER TIME OF MOVE-IN.

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* 19. SIGNATURE of APPLICANT:

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* 20. Date

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* 21. SIGNATURE of HOUSE MANAGER:

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* 22. Date

* 9.
I agree that no visitors, children or people of the opposite sex are allowed on SALS Recovery House property at any time, unless approved by SALS Staff.