A Way-Out Intake Application Form

Resident Application

Welcome to one of the A Way Out Sober Living (AWOSL). We believe in two fundamental recovery concepts: ACCOUNTABILITY and ACTION. We have developed expectations for each sober living home based on these two crucially important recovery practices. Provided below are clear expectations for  all new residents to read, understand, and demonstrate at all times--while living in one of our homes. 

 Personal/General Info

Instructions: To be accepted into residency, this application and an interview process must be completed, Carefully read this application and honestly answer all questions that apply to you. This information will remain confidential and be available only to management.

Your Information
First Name        Client first name
Last Name        Client last name
Date of Birth      Client birthdate
Email                 Client email
Phone Number  Client phone
Most Recent Address Client AddressClient CityClient StateClient Zip
Marital Status    Client marital status

Num of Dependants Text field
Allergies                   Client allergies

Profile Picture (not sure how to add a button for the client to upload the picture)

Ethnicity    Client ethnicity

Image of Photo ID or Drivers License (upload pic, not sure how to add)

Driver's License # Text field

Do you smoke/vape? Dropdown
Drug of Choice Client substances of choice
RecoveryHistory  (dont need the relapse date in recovery history)
Longest Period of Sobriety Text field

 Referral Source

Where are you coming from?  TreatmentCenterHistory

Therapist/Clinician

Referral Point of Contact Email Text field

Referral Point of Contact Phone Number Text field

Recovery Program 

Last treatment/sober house, and start dateSoberLivingHistory

Medical Conditions

Prescribed Medications Client medical notes
***Medications: All medications other than tylenol, ibuprofen or multivitamins need to be kept in a lock box if you don’t have a lock box you will have one week to get one. If you have a prescription for methadone,suboxone, medical marijuana and you have not already you need to sign a release for AWOSL to communicate with that particular provider.

Employment   

EmploymentHistory

Emergency Contact

Family Members (dont need the DOB of the family member, living together)

Legal Details

Criminal History

This is a legal and binding document. Please read it very carefully.

1. I have carefully read and truthfully answered all applicable questions above. I agree to provide an update information if any of my answers change while I am a resident of A Way Out Sober Living (AWOSL).

2. I realize that AWOSL has been established in compliance with the conditions of §2036 of the Federal Anti-Drug Abuse Act of 1988, P.L. 100-690 (as amended), which provides in pertinent part that a sober house:

• Prohibit all residents from using any alcohol or illegal mind-altering substances

• Expel any resident who violates such prohibition

• Share household expenses including the monthly program fees among residents

• Utilize democratic decision making within the group where appropriate including inclusion and exclusion from the group

3. I have been provided with a copy of and have read and fully understand the Rules and Expectations of AWOSL.

4. I am currently of sound mind and not under the influence of any drugs or alcohol.

 5. I agree that I am a participant in a program and not a tenant. I agree that I am not protected by, nor will I invoke any protections of local landlord/tenant laws. If it is found that local landlord tenant laws apply, I hereby renounce any rights that I may or may not have arising under the same.

 6. I agree that I will participate in the programs of AWOSL and will abide by all its Rules and Expectations.

 7. I specifically agree that if I violate any of the Rules and expectations of , I can be expelled from AWOSL and forfeit any rights to my sober deposit and prepaid program fees. I agree that final determination of any disciplinary action will be made by AWOSL and may not be appealed.

 8. I hereby release and hold harmless AWOSL and all its managers, employees, members and agents from any and all lawsuits of whatever nature that may be brought by me, my heirs an update information if any of my answers change while I am a resident of AWOSL. members and agents from any and all lawsuits of whatever nature that may be brought by me, my heirs and/or my representatives in perpetuity.

  9. In accordance with state and federal law and the principles of a 12 step program, AWOSL does not discriminate based upon race, color, religion, sex, national origin, disability, sexual orientation, HIV or Hepatitis status. By my initials, I agree to these principles and acknowledge that I may be living in the same house as a member of a protected group.

 10. I agree that I am ultimately responsible for my own valuables and other personal property, during and after my residency at AWOSL.

 11. I agree to pay AWOSL a Sober Deposit of $500 before gaining residence at AWOSL. If residence is terminated for violating AWOSL Rules and Expectations as set forth in this agreement, the Sober Deposit and any other paid fees or rents will not be refunded. Otherwise, the Sober Deposit will be refunded upon voluntary termination less any fees for damage and/or unpaid balance(s). This is a 90 Day commitment to live here.

12. Prior to move-in: $500 refundable sober deposit +  first month’s program fees. Program fees are as follows $750 for a double room, $850 for a single room.  Step up houses are $1050 per month.

 13.Sober deposit will be returned to the person that gave the deposit, once a 30-day notice is given prior to moving, and if there is no property damage and within 1 week of leaving the program.

 14. While in treatment rent reduction is based upon which facility you attend and your involvement.

 15. There are many ways to pay your rent/deposit: Venmo, CashApp, PayPal, money order or check. We will no longer accept cash. Venmo payments can be made to @Derrick-Haase and Money orders made payable to AWOSL.  There will be a non-refundable $25.00 fee on all returned checks. 

 16. Attend at least one weekly recovery meeting of your choice and obtain a sponsor/mentor.  

 17. Utilize your house manager to resolve conflicts within the house and be proactive in the solution. 

 18. Obtain employment—if you don’t have a job, you should be spending a minimum of 30 hours/week seeking a job OR volunteering in the community. school or treatment.  

 19. If you hold yourself accountable, ask for help, and become action-oriented, you will increase the probability of a successful recovery. Shifting our focus to ownership and accountability. 

 20. There will be a strict NO cellphone in house meetings. 

 21. We suggest meeting with a Peer Recovery Specialist to assist you with applying for any financial assistance or other needs you may have.  Peer Recovery Specialist is here to help you build a successful recovery-oriented action plan.  Utilize the support you are being offered. We are here to help and ensure you have a long and fruitful recovery journey. You don't know what services are available until you ask. 

 22. Program fees are to be paid in full by the 1st of the month a $50 late fee will be added to your account. If not paid by the 3rd without an agreement or plan you will be asked to leave.  If unable, please work with a Peer Recovery Specialist before the date on a plan to get on track and discuss possible options. The plan will then be forwarded to the Operations Manager for approval. Once approved, expectations should be followed. If not, this could jeopardize your stay at an (AWOSL).

 23. A 3-month agreement will be signed–with a month to month renewal if all rules and expectations are being followed..  

24. Curfew: 11 pm curfew Sunday-Thursday. 1 am curfew Friday-Saturday. All curfew questions or adjustments need to be communicated with the house manager as soon as you are made aware of these changes that need to be made. Curfew that is broken without prior approval and communication will result in a 8pm curfew for 1 week with a success contract filled out and adheared to. 

25. It is expected if there is an overnight request it will be turned in the week prior. Preferable at the house meeting. Exceptions can be made and those need to be discussed between the client, house manager. Overnight or curfew extensions, etc.  are given to those who follow program and house expectations. These privileges can be taken away if these guidelines are not followed. Once these have been revoked they will need to be earned back by following the rules and expectations within the home.  

26. Residents MUST attend all weekly house meetings, sharing openly and respectfully, and demonstrating solution-oriented thinking. You’re now part of a team—do your part.

27. Weekly house meetings should consist of discussions regarding goals, struggles, successes, concerns, and needs of the house and those in it.  These are mandatory meetings and can not be missed if missed can result in discharge of program.

28. Chore lists will be reviewed, and changes made during weekly house meetings (this includes discussion regarding why some chores are not being completed). Daily chores must also be completed prior to the house manager’s evening review. There is a strict expectation on chores if they are not completed a verbal request to complete chore will be made by house manager and if not completed after verbal request then its a write up. This is to ensure a safe and habitable living environment for all who live there.  Penalty will be losing extra privileges.

29. AWOSL are obviously abstinence-based with absolutely no tolerance. As well as the following are NOT permitted and can result in discharge Zero Tolerance ; violence or threat of, theft, gambling, curfew violations, sex, weapons, using or selling any controlled substances/alcohol, abusive language, borrowing or lending will be tolerated. These acts and behaviors need to be reported to the house manager or operations manager immediately. Random drug /Alcohol testing will be done by the house manager.  Absence from all non prescribed medications is absolutely necessary. Positive Urine Analysis: You will be given two options. 

a. Option One: admit into detox and then meet with operations manager and house manager prior to readmission into the program. Residents must pass a drug/alcohol test to be able to be readmitted. There will need to be a commitment to absence and plan to avoid future reuse. Meeting with our Peer Recovery Specialist to work through challenges or needs. Allowance back into the house is on an individual basis . 
b. Option two: given 30 minutes to gather belongings and arrange a ride to leave sober residence. 
30. Residents will plan, prepare, and participate in a weekly house meal. In addition, this can also include movie or game nights, attending community support meetings together, and/or united leisure activities (e.g., Vikings game, MOA, etc.). The rest of the house can pitch in one item to ensure a nice meal is eaten together. Cooking, clean-up and preparation is a community event.

31. AWOSL will provide cleaning supplies, garbage bags, toilet paper (including brushes and plungers), coffee, light bulbs, and batteries. 

32. Not Allowed: NO SMOKING OR VAPING IN THE HOUSE. There are no candles or incense allowed to be lit/burned in the sober residence ever. Windows are to stay closed at all times while the air conditioner/heat is running. All windows and doors must be locked at all times. This is a safety/energy issue and there are no exceptions.

33.  Personal Space: You are required to keep your space clean and neat. Beds made before leaving the house or once out of the bed in the morning, trash taken out, and clothes put away. There are no food and drinks allowed in rooms. Water is the only exception. You are expected to not leave personal belongings in the common area. Bedding needs to be washed once a week and hygiene needs to be done daily. you live with other people and everyone needs to do their part in maintaining personal and community hygiene.

34. Guests: Are not allowed in the recovery residence without prior approval from the house manager and the operations manager. No members of the opposite sex are allowed in the house except blood related family or spouse. 

35. Residents must be willing to assist the management or other residents in time of need to be a witness and or support when needed.  Ex. when discharging another resident.

36. AWOSL management reserves the rights to disclose UA's results to other residents of the sober house. Additionally, resident agrees to release all rights to photographs taken as part of AWOSL events. This includes AWOSL's rights to use said photographs in promotional material.

37. Termination/Trespassing agreement procedure and policy : Failure to meet and follow through with all agreements and signed expectations of (AWOSL) and asked to leave the Recovery Residence, is immediate and failure to comply with the request will result in the police department being called and notification made that you are trespassing on the property. Once trespassed from the property and asked to not return and return to the property for any reason can result in criminal action for trespassing. You will be asked to take your belongings at that time failure to do so will result in forfeiture of belongings, unless arrangements are made with Recovery Resident House Manager and Operations Manager to pick items up at a later date. 

It is valid until the last day of programming and or violation of expectations and asked to leave (AWOSL) or last day of trespassing order. Once trespassed, that is a new law abiding agreement that must be followed and failure to follow can result in criminal actions and arrest.

A Way Out Sober Living – House Rules & Expectations

A safe, structured, and supportive environment for your recovery journey

1. Sobriety & Wellness

✅ Zero Tolerance Policy

No alcohol, illicit drugs, or misuse of prescription medications.
Random drug/alcohol testing will be conducted. Refusal = automatic violation.
Relapse protocol: Immediate staff notification required for support. Minimum 72-hour detox to be considered for return.
✅ Recovery Meeting Requirements

Minimum 1 meeting per week (AA, NA, SMART Recovery, or approved alternatives).
Sign-in sheets or meeting logs may be requested for verification.
✅ Medication Management

All prescriptions must be registered with House Manager and stored securely.
No sharing medications. Non-compliance will result in discharge.
Take medication as prescribed. Abusing medication is grounds for discharge.

2. Daily Structure & Responsibilities

🕒 Curfew & Check-

First 30 Days, No Overnights, Sun-Thursday 9:00PM Curfew, Friday and Saturday 11.00PM Curfew. After 30 Days:
Sunday–Thursday: 11:00 PM
Friday & Saturday: 1:00 AM
All residents must check in with staff upon returning home.
Overnight Passes require a 24-hour notice posted on Group Me. Group Me must be downloaded on Cell Phone. 

🧹 Chores & Cleanliness

Daily and weekly chore assignments (posted in common areas).
Personal spaces (bedroom/bathroom) must be kept tidy. Inspections weekly.
Inspections conducted weekly.
Non-Compliance = Loss of privileges or discharge
💼 Employment/Program Participation

📌 Core Requirement

All residents must dedicate a minimum of 30 hours weekly to structured recovery activities, beginning within 14 days of arrival.

 ✅ Approved Activities

 1. Employment (Preferred)
• Full-time or part-time jobs
• Temporary/seasonal work
• Paid internships
2. Education/Vocational Training
• College courses (credit/non-credit)
• GED programs
• Trade school/certification programs
3. Recovery Programming
• Outpatient treatment (IOP/PHP)
• Mental health counseling
• Sober coaching sessions
4. Community Engagement
• Volunteer work (minimum 10 hrs/week)
• Recovery meeting attendance (AA/NA/SMART)
• Fitness programs (gym, yoga, recovery sports leagues)
5. GRH/Subsidized Housing Participants
• Must discuss weekly activities with House Manager for Compliance.
• 30-hour weekly minimum through:

• Recovery meetings (minimum 1/week)
• Outpatient Treatment
• Volunteer work
• Physical activity (tracked via log)
• Life skills classes
• Working
   

3. Visitors & Community Conduct

👥 Guest Policy

No overnight guests 
Daytime visitors (2:00 PM–8:00 PM only) must be pre-approved and sober.
All Guest must stay within Common Areas. No Bedrooms or Hallways.
Absolutely no former using buddies or enablers permitted.
🤝 Respect & Confidentiality

No violence, threats, or theft. Immediate discharge for violations.
What’s shared in the house stays in the house.
🔇 Quiet Hours

10:00 PM–7:00 AM (no loud music/TV, phone calls in common areas).

4. Financial & Logistical Policies

💵 Rent & Fees

Rent due 1st of every month. Late fees: $50.00 after 48 hours. Late fees will double every month the fee is not paid.
Overnight privileges will be revoked until all late fees and rent are current.
Coin Operated Washer and Dryer. $1.50 per load. (Only in homes with Coin Operated laundry) 
🚗 Transportation & Parking

Vehicle registration required if parked on-site.
No lending/borrowing cars without staff approval.
📱 Phone & Internet Use

Limited screen time in common areas (encourage community bonding).
No social media contact with active addicts/dealers.
House computers are used for job and assistance searching. No altering or adding programs to the computer.
5. Accountability & Support

📅 Mandatory House Meetings

Held every week. See house manager for day and time. House meetings are Required attendence. 
⚠️ Violations & Warnings

1st offense: Written warning + action plan / Success Contract.
2nd offense: Eviction
"These rules exist to protect your recovery—not to restrict you. We’re here to help you succeed!"

Laundry Schedule: Posted in laundry room (avoid conflicts).
Food/Kitchen Rules: Label personal items, clean dishes immediately. A refrigerator and freezer shelf will be assigned to you. As well as pantry room for dry goods.
Smoking: Designated outdoor areas only; no smoking inside.
Marijuana: Approved with verification of Medical I.D. Card. No Flower smoking on grounds. Gummies / Edibles are the only form of approved marijuana.
Emergency Drills: Fire/evacuation procedures reviewed monthly.
Privacy and Searches: Management has the right to access personal areas and conduct searches to ensure compliance with house rules. Residents are not allowed to enter another resident’s room unless assigned to that room. Residents entering rooms without permission will be discharged.
Pets – Not Allowed (see separate agreement for conditions)
Dress Code and Personal Conduct: Residents must dress appropriately and avoid clothing with offensive logos or messages. Personal conduct and hygiene should reflect the values of respect and responsibility. Respectful Behavior Includes:
✓ Using polite language
✓ Maintaining appropriate volume
✓ Respecting personal boundaries
✓ Addressing conflicts through staff
Zero Tolerance For:
✗ Bullying or harassment
✗ Sexual comments/advances
✗ Racial/religious slurs
✗ Threatening body language
Your appearance and conduct impact your recovery and our community. We uphold these standards to maintain a dignified living environment for all."A

A Way Out Sober Living (AWOSL) Photo & Testimonial Release Waive

I, (Residenty at (AWOSL Home Location), grant AWOSL and its affiliates the right to:

      1. Use my photograph(s), likeness, voice and /or testimonials in:

             - Social media (Facebook, Instagram, etc.)

             - AWOSL newsletters, websites, brochures, or promotions.

             - Revovery-related public campaigns. 

      2. Edit materials for clarity/space without distorting meaning. 

      3. Use my first name and last initial (e.g., "John D.") unless I consent to Full-name. Sign Below.

Terms & Conditions

      1. Durations: 2 years from signing (renewable). Revocable anytime via written notice. (prior uses may remain).

      2. No Compensation: I waive payment for participation. 

      3. Sober & Voluntary Consent: I confrim sound mind and voluntary agreement. 

By Signing below you agree to above Resident Applicaton Terms, Photo & Testimonial Release and conditions. 

Revocation Address:  Derrick Hass, AWOSL, 22851 MN-15, Dassel, MN 55325

 

Client Signature    Date:Date   Witness Signature  Date: Date