Have you had any of the following tests?
Do you have a RSS Housing Voucher through Dismas House Access Site?
If NO, you must contact Dismas House of KC at 816-542-0445 option 2 for assessment and intake.
Can you pay the $100 Deposit on Admission (not covered by the RSS voucher)?
Waiver of Liabilities
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.
PROGRAM PARTICIPANT WAIVER OF LIABILITY
I release Ozark Recovery Housing as an organization, its administrative staff, or any program support service provider from any liability due to personal physical or mental injury while staying at the Men’s/ Woman's House. This pertains to any injury while on the property, or while being transported in any organizational or staff personal vehicle.
RELEASE OF INFORMATION
I hereby authorize the release of information I understand that information will be communicated verbally and or in written form. Information concerning psychiatric, psychological, medical diagnosis, drug or alcohol abuse, economic status, and educational information will be released and/or communicated if indicated below. I authorize the following information to be released to Ozark Recovery Housing LLC.
• Treatment Plans
• Substance Abuse Treatment Records
• Treatment / Discharge Summaries
• Social and/or Developmental History
• Health / Medical Records
• Restorative Support Services Academic / School-related Record
• Social Support Services (Food, Clothing, Shelter)
• Grades and Test Scores
• Attendance receive this information, specific individuals must be named
• Suspensions / Expulsions above
• Exceptional Student Education / Section 504 records
• Other : Probation and Parole
-Current sober living provider
I acknowledge that all information I authorize to be released or requested will be held strictly confidential. I understand this authorization will expire one (1) year after the date signed.
PROGRAM PARTICIPANT PERSONAL PROPERTY WAIVER OF LIABILITY
Initials Text field I agree to accept full responsibility for any personal property, I have been advised to not bring any item of sentimental or significant monetary value into Ozark Recovery Housing LLC because of risk of loss or theft.
Initials Text fieldI agree to hold the Ozark Recovery Housing LLC staff harmless or responsible in any way, shape, form and/or fashion, from any and all losses I may have, from theft or otherwise. I understand that my belongings are not insured unless I obtain my own insurance policy at my own cost.
Initials Text fieldUpon leaving, Ozark Recovery Housing LLC for any reason whatsoever, I will immediately remove my personal belongings at the time of discharge. Ozark Recovery Housing LLC does not store any items for any reason beyond discharge, and it is for this reason that residents are advised to not bring in more items than they can carry out within one hour. All personal belongings left behind after 24 hours will be donated without compensation on the 25th hour.
Ozark Recovery Housing LLC, through its’ transitional living program, provides housing as a part of the program and in no way implies the establishment of residency. Participants in the program are permitted to utilize the housing provided by Ozark Recovery Housing LLC for a monthly fee. In order for the participant to retain housing as a part of their program, they must follow and adhere to all housing guidelines and program policies and procedures. In the event a participant in the program violates any provision that requires immediate removal, their caseworker will be notified for pick-up and they will be removed
MANDATORY PROGRAM PARTICIPATION ACKNOWLEDGEMENT
Ozark Recovery Housing LLC requires each of its’ participants to enroll in affiliate programs that provide supportive services. If Ozark Recovery Housing LLC has agreements with local agencies that provide workforce development, job readiness, substance abuse support, transportation, education and training, and food, qualified participants are required to enroll. Our agreements support the transitional living program and participation is mandatory.
HOUSE MEETING ACKNOWLEDGEMENT
All individuals participating in the Ozark Recovery Housing LLC's transitional living program are required to attend weekly/monthly house meetings and groups. These meetings are designed to ensure proper communication channels are open with participants and staff. Attendance is required.
All participants who are prescribed medication by a medical doctor are required to adhere to the directions of their doctor. If medication regiments are not followed, it can be grounds for immediate removal at the discretion of management.