Sober Soldierz House Application

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Today's Date

Name

First

Last

Date of Birth

Address

Phone

SSN

Marital Status

Married
Single
Divorced
Life Partner

Emergency Contact Name

First

Last

Relationship

Emergency Contact Address

Phone

In the past 30 days, where have you been living?

Referral Source

Do you have any physical health issues and/or concerns?

If yes, please describe. Are you being treated for these issues by a medical professional?

Do you have any mental health issues and/or concerns?

If yes, please describe. Are you being treated for these issues by a medical professional?

List of medications, dosage, and frequency

When was the date of your last physical?

Date

Time

When was the date of your last TB test?

Date

Time

Check if you understand both these items will need to be completed with proof of documentation prior to becoming a resident in the home

Yes I understand I need proof of documentation

Did you read the house rules and financial obligations?

Are you clear on what is expected of you?

I (Name) authorize SOBER SOLDIERZ HOME to share information included in this application with relevant legal and medical agencies to confirm the information I provided on this application to be accurate. I attest that the information I provided is true to the best of my abilities.

with use understand

Name

First

Last

SOBER SOLDIERZ HOME RULES
Residents must obtain employment within two weeks of move-in date.
There is ZERO tolerance for durg and/or alcohol use.
No tobacco in the house this includes SMOKING, VAPING, and CHEWING. THere is a designated smoking area outside and it is expected to be kept clean.
Curfew is set at 10:00 pm Sunday-Thursday and 11:00pm Friday and Saturday.
*Residents must attend all Sober Soldierz meetings, Morning Toby world wide, live and events each week.
Weekly schedule is posted in the messenger group.
Guests are allowed ONLY in common areas of the house.
No guests may stay overnight.
Random urinalysis screenings will be administered by SS. Releases of information for Houseman and Liaison will be required to ensure the continuity of care
Residents must follow continuing care plan estabished with SS.
Residents must have a list of resources available for any assistance they may need.
Residents are assigned weekly chores and it is an expectation to clean up after on's self daily (as-you-go)
Arrest and/or incarceration will void contract.
Any physical altercations will void contract.
NO STEALING. This includes taking food or belongings from others.
Only Houseman can change thermostat.
No sexual offenders allowed.
Residents on disability must volunteer or do community service a minimum of 30 hours/week must get approval from Liaison.
Residents are expected to work a recovery program while living in the Sober Soldierz Home.
REsidents in the first 30 days are on a probationary period and are subject to the following rules:
-Curfew is 9pm daily during the first 40 days
Residents can furlough Friday and Saturday nights with prior approbal from liaison AND if they are current on rent.
Residents must attend all mandatory Sober Soldierz meetings and church
Residents probationary period ends after 40 days if current on rent and fulfilling all obligations previously outlined. See guidelines and obligations sheet provided by T.J.
Residents must attend Monday night 6pm house meetings.
ALL HOUSES AND RESIDENTS: You must be current on rent to furlough-- If you are behind on rent, the furlough request will be denied.

SOBER SOLDIERZ HOUSING FINANCIAL OBLIGATION
Before mobing into the house, you are required to have $550 first month's rent and $200 non refundable deposit (No exceptions). You will need to have your monthly $550 rent at the first of each month (this is a MANDATORY)

I (Name), acknowledge that I have read the Sober Soliderz agreement and that I understand the financial obligations expected of me. I agree to abide by these rules and financial guidelines if I become a resident of the house. I also agree to attend occasional mandatory house meetings or events along with the other residents.

Name

First

Middle

Last