Revised 11-2-2025
New Member Agreement
Please Print First & Last Name
Client first name Client last name
I agree to the following conditions as a member of a Recover Revolution house:
- I understand that possession or use of alcohol or drugs, on or off the
property, will result in expulsion. Synthetic or natural mood/mind-altering
substances (including but not limited to THC, K2, Kratom) are not
permitted. Only nicotine and caffeine are allowed.
- I will abide by all laws regarding prescription medications, including no
trading, holding, borrowing, bartering, or swapping.
- No prescription medications shall be brought into the house without prior
notification to the house by submitting a Medication form through the House
member section on the Recover Revolution website.
- I am responsible for my personal belongings and will not leave them in
common areas. Upon departure or expulsion, I agree to arrange retrieval of
my belongings within seven (7) days.
- I understand my move-in fee of $350 is non-refundable.
- I understand my attendance at weekly house meetings is mandatory to
review house events and provide updates on my recovery progress.
- I understand that I am on a probationary “blackout” period for a minimum of
30 days. The blackout may be ended or extended after house review.
- I agree to uphold and follow all house policies and procedures.
- I understand that if I exceed 24 hours with no contact, a missing person
report may be filed. If gone longer than 72 hours, my belongings may be
packed, and I may lose my bed or room.
- I agree to attend a minimum of three (3) recovery activities weekly, in
addition to aftercare, IOP, probation, or Recovery Court requirements.
Financial Responsibility
1. My living costs are due in advance at the beginning of each 7-day period.
2. If I incur any negative balance, I will be placed on corrective action.
3. While on corrective action, I will not be permitted to allow my balance to go
further negative. I must contribute my full weekly share of living expenses
on time. The back balance payment period shall be determined by the house
conscience. However, under no circumstance shall exceed 6 months.
4. If house members fail to place a member who is in arrears on corrective
action, they may be held collectively responsible for that balance, which will
be divided equally and added to each member’s equal share of living
expense balance.
5. To avoid responsibility for another member’s balance, I agree, along with
my fellow members, to hold each other accountable in writing using the
Corrective Action Form.
Emergency Medical Information Release Form
This form is to be used for emergency medical use only:
Name:
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Phone:
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Age:
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Date of Birth:
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Clean/Sober Date:
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Blood Type:
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Insurance provider:
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Allergies:
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Medications:
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Medical History (major surgeries, contracted diseases, health problems, etc):
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Emergency Contact/Next of Kin:
1. Name:
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Phone #:
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2. Name:
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Phone #:
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3. Name:
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Phone #:
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I hereby give my consent for emergency medical treatment:
First and Last Name
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SIGNATURE:
Signature
DATE:
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By continuing, you agree that your electronic signature is the legally binding equivalent to your handwritten signature. Whenever you execute an electronic signature, it has the same validity and meaning as your handwritten signature. You will not, at any time in the future, repudiate the meaning of your electronic signature or claim that your electronic signature is not legally binding.
RECOVERY PLAN
Name:
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Date:
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My plans to follow up in my recovery are:
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How will I get to recovery activities, IOP, Recovery Court, probation, Dr
appointments, work, or other potential mandated or volunteer activities?
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Do you have a Sponsor?
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If you do not, how soon do you plan to obtain a sponsor?
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If I do not plan on getting a sponsor what will my plan be?
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I plan to attend Text field
AA/NA/SMART/ALL/REFUGE/CA/MA/CMA/HA/Other meetings per week.
I am using Text field book(s) for my Daily Meditation.
Drug/Alcohol (UA) Test Consent Form
- I am subject to drug/alcohol testing at any time.
- When two or more house members request a test, I must provide a sample
within two hours. Unless otherwise agreed collectively by house conscience.
(Collective spiritual wisdom that guides a house's decisions and ensures it
remains focused on its primary purpose of helping addicts recover.)
- A tampered or positive test will result in expulsion.
- If sent to a lab, I must pay $75 upfront. If confirmed false positive, the fee
applies to my living costs. If confirmed positive, the fee is forfeited and I
will be expelled.
- Refusal to comply results in expulsion.
- A member who follows house recommendations may be granted an
interview for re-entry at the lowest seniority level. If they refuse agreed
treatment or leave without following the plan, they forfeit this
opportunity for at least (30) days. After that period, 30 days, they must
restart the process with a new interview, move-in fee, and living
expenses.
Personal Property/Space & Grievances
Member Name:
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List item/s with detail including serial # and/or other distinguishable information. Although the
house is not responsible for items listed, we will do our best to secure these items in the event of your unforeseen absence.
Date:
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Property of House Member:
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RR Intials
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The House/Recover Revolution is not responsible for items listed above or any other
personal items. This list is to make the house aware of personal items that you hold of
value whether nostalgic or monetarily and we will make a special effort to secure these
items in the event of your absence.
I, Text field, understand that I will not go into another house
member’s personal space unless given explicit communication to do so or house conscience
has determined that a room search is called for.
I, Text field, agree to resolve grievances within a timely manner
in an atmosphere of open communication and mutual respect. Furthermore, I understand
that I may contact a Chapter President or any trusted servant/outreach worker of Recover
Revolution if guidance is needed for a resolution.
I, Text field, understand that at least two house members must
be present to enter and clean out a room or personal space of a vacated house member(s).
Never should one person clean up a vacated room alone. It is recommended to have at least
one executive house member or outreach worker be present to clean out a room.
I, Text field, agree that if I am one of the house members
cleaning out a room, that I will pack up, label and date the bags or boxes with the person’s
name and date and place said items in agreed storage in the house.
House Rules & Guidelines
- All members must provide a UA upon request by 2+ house members.
- All members must pay living costs on time, per the Financial Responsibility section.
- All members must keep residence in good condition and complete chores weekly.
- All blackout rules must be followed for at least 30 days (curfew, no overnight guests).
- After blackout: no curfew; up to 3 nights away or with guests weekly (no more
than 2 consecutive). Must inform house members of all overnight activity (use
group text for clarity is recommended).
- Physical or verbal abuse results in corrective action and possible expulsion.
- All members shall hold each other accountable in the spirit of supporting and
uplifting one another. Behavior inconsistent with a recovery-focused
atmosphere should be documented in corrective action forms to ensure clarity and respect.
Off-Blackout Checklist
To be reviewed at house meeting after 30 days:
- Is member attending required recovery activities?
- Is member completing chores?
- Is member employed or otherwise contributing?
- Is member up to date on living expenses?
- Has member submitted all required documents?
House may vote by majority to lift or extend blackout, or by unanimous vote to expel.
Final Acknowledgments
1. As a member of this house, I understand that we are all in this together. It is
our collective responsibility to support each other in recovery, attend
meetings, complete responsibilities, and hold each other accountable.
2. As a member of this house, I understand that in the interest of neurological,
pulmonary, and general environmental health we as a collective will use
chemical free non-toxic cleaning supplies.
3. As a member of the house, I understand that individually and collectively we
must follow all lease agreements with the landlord, township ordinances and
apply good neighbor policy (law-abiding, considerate, and actively
contributing to the safety and stability of the community).
4. Room choice is 1 st offered to the member with the highest seniority who is in
good financial standing. If the most senior member declines the room or
bed, it will then be offered to the next member in line by seniority. Any
disputes are to be discussed and resolved during the weekly house meeting
by majority vote.
Print Member Name:
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Member Signature:
Signature
Print House Executive Member Name:
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House Executive Member Signature:
Signature
By continuing, you agree that your electronic signature is the legally binding equivalent to your handwritten signature. Whenever you execute an electronic signature, it has the same validity and meaning as your handwritten signature. You will not, at any time in the future, repudiate the meaning of your electronic signature or claim that your electronic signature is not legally binding.