One Step

Program Handbook and Consent Forms

PROGRAM HANDBOOK

FIRST NAME: Client first name LAST NAME: Client last name IDOC # Text field

Welcome to The Nova Residence!

We truly believe that a clean, safe and sober living environment is paramount in fostering a lasting healthy and sober lifestyle. Our goal at The Nova Residence is to help reintroduce our program participants to a stable home environment so that you can flourish on your own. We have created this Housing Handbook to help guide you through The Nova Residence policies and procedures.

Your first task now that you’ve arrived will be to call us directly so we can walk you through your next steps and guide you through what you can expect. If you do not yet have a phone, you may use the house phone to reach us at (888) NOVA-208 or (888) 668-2208. We can advise what room and bed number has been assigned to you.

You’ll then need to review and sign our Program Handbook. If you have internet access, you may sign these documents electronically on our website:

1. Go to www.thenovaresidence.com

a. On a computer, on the top of the screen, click on Resources and then select Program Resources from the dropdown menu

b. On your phone, click on the 3 lines at the top left, Click on Resources and then select Program Resources from the dropdown menu

2. Click on Program Handbook which will bring you to the documents to sign electronically.

3. When typing your name on the form, please input your full first and last name.

Take your time acclimating yourself to the house. We have already discussed your move in with a current program participant who will find you to introduce themselves and give you a tour of the house within the next day.

Should you ever have any questions or concerns, please don’t hesitate to reach out to the House Manager, to management via the website or directly at (888) 668-2208.

We look forward to having you.

The Nova Residence

PROGRAM HANDBOOK

Please take the time to read through these policies as you will be required to sign and acknowledge that you have received these and will abide by the policies herein.

Included in this Program Handbook are the following policies:

House Rules

Anti-Harassment Policy

Chore Schedule

Complaint Policy

Complaint Form

Conduct Policy

Drug Testing Policy

Payment Policy

Transportation Policy

Release of Liability

Release of Property

Consent Form

HOUSE RULES

1. Absolutely no alcohol and/or drugs on or off the premises while in housing. Narcotics and controlled substances are not allowed. We practice TOTAL ABSTINENCE from all mind-altering substances, legal or illegal including Spice, Kratom, Bath Salts and designer drugs. Medication-Assisted Treatment programs are allowed and must be reported to staff prior to use of the medication.

2. Daily Check in/out on the house Sign Out Board is Required. Nightly Curfew. Exceptions are made for work schedules and special circumstances with PRIOR approval. Program participants on probation/parole need PO permission. Curfew violators will be required to pass a drug test upon return. Urinalysis fee is $35. For program participants on probation/parole, PO will be notified.

3. Submit to random drug/alcohol testing. If unwilling or unable to produce a sample for drug testing, program participant agrees to leave premises immediately and not return until a negative test result can be provided. For program participants on probation/parole, PO will be notified.

4. Agree to random searches of personal property on premises. We have an open-door policy with Law Enforcement, Probation/ Parole, and Court Service Programs. All program participants agree to be respectful and cooperate with all law enforcement regardless of supervision status.

5. Agree to abide by the Program Handbook and its contained policies including but not limited to Conduct, Harassment/Discrimination, Transportation, Drug Testing, Payment and Chores.

6. Smoking/vaping allowed outside only in designated areas. Smoking/vaping inside will result in discharged.

7. No visitors are allowed, to ensure our home remains Safe, Clean, and Sober.

8. Verbal or physical violence towards another program participant or staff will result in discharge.

9. Agree to make bed and pick up all personal areas and belongings before leaving each day. Further agree to complete shared house chores as posted on the Chore Schedule or assigned by the House Manager.

10. No romantic/intimate relationships with other program participants.

11. Agree to work a program of recovery while in housing. If not yet employed, agree to attend one AA/NA meeting or complete one hour of community service each day.

12. No pets of any kind are allowed in housing.

13. Only one vehicle per licensed program participant is allowed. Vehicle must be in good working order. Maintenance of vehicles is not allowed on or around property, under any circumstances. Verification of license, registration and insurance is required for vehicle to be on property.

14. If House Rules or Policies contained in the Housing Handbook are violated, you agree to whatever consequence deemed necessary by Staff ranging from a 24-Hour *Standout to Discharge. (*Standout - A specified number of days when a program participant is excluded from the house.)

Anti-Harassment Policy

1. OVERVIEW

The Nova Residence (the Company) is committed to providing an environment free of discrimination and/or harassment. We prohibit discrimination/harassment at The Nova Residence, whether committed by or against program participants, managers, colleagues, customers, suppliers or visitors. We want our staff, program participants, and visitors to have a healthy, respectful and productive environment.

Discrimination or harassment at The Nova Residence based on race, color, religion, sex, national origin, citizenship, age, sexual orientation, disability, marital status or any other basis prohibited by law, will not be tolerated. The Company prohibits inappropriate conduct based on any of the above characteristics at The Nova Residence, in the company’s business or at events sponsored by the company.

2. SCOPE

This policy applies to all current employees of The Nova Residence, including full-time and part-time, contractual, permanent and temporary employees and also applies to job applicants and program participants.

This policy applies to all behavior at any Nova Residence premises and/or related in any way to work, including off-site meetings, trainings and business trips.

3. HARASSMENT/DISCRIMINATION DEFINITION

Harassment/Discrimination

Harassment/discrimination is unwanted, unreasonable and offensive behavior towards the person being harassed, which creates an intimidating, hostile, or humiliating environment for the person concerned.

There are different types of harassment that can occur:

· Race, ethnic origin, nationality or skin color

· Gender identity and/or sexual orientation

· Religious or political convictions

· Membership or non-membership of a trade union

· Disabilities, illness, sensory impairments or learning difficulties

· Age

· Pregnancy/maternity/paternity

This list is not exhaustive.

Harassment is:

· Offending or humiliating someone physically or verbally;

· Threatening or intimidating someone;

· Making unwelcome jokes or comments about someone’s race, national or ethnic origin, color, religion, age, sex, sexual orientation, marital status, family status, disability or pardoned conviction

Harassment can occur between people of the same sex or opposite sex.

Sexual Harassment

Sexual harassment has been defined as unwanted and unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature that:

· Is made either explicitly or implicitly a term or condition of employment

· Issued as a basis for employment decisions affecting such an individual;

· Has the purpose or effect of substantially interfering with an individual’s work performance and of creating an intimidating, hostile, or offensive work environment.

The Company prohibits inappropriate conduct that is sexual in nature on any Company premises, at work, on company business, or at company-sponsored events including the following:

· Offensive or humiliating behavior that is related to a person’s sex;

· Behavior of a sexual nature that creates an intimidating, unwelcome, hostile or offensive environment;

· Behavior of a sexual nature that could reasonably be thought to put sexual conditions on a person’s job or employment opportunities

· Comments, jokes or degrading language

· Sexually suggestive objects, books, magazines, photography, cartoons, pictures, calendars, posters, electronic communications, or other materials;

· Unwelcome sexual advances, requests for sexual favors, or any sexual touching

· Offering favorable terms or conditions of employment or benefits in exchange for sexual favors or threatening or imposing less-favorable terms or conditions of employment if sexual favors are refused

Sexual harassment is prohibited whether it is between a member of the opposite sex or members of the same sex.

4. MANAGEMENT AND STAFF RESPONSIBILITY

All managers have a responsibility to maintain an environment free of discrimination and personal harassment. Managers are directly responsible for the conduct of their staff and the smooth running of their department.

Also, The Nova Residence expects all employees and program participants to comply with this policy and all employees and program participants to conduct themselves appropriately.

Management is responsible for:

· Promoting a harassment-free environment and setting an example of appropriate behavior;

· Communicating the process for investigating and resolving harassment complaints filed ;

· Dealing with harassment situations immediately after becoming aware of them, whether or not a harassment complaint has been made;

· Taking appropriate action during a harassment investigation, including separation of the parties to the harassment complaint, if necessary; and

· Ensuring that harassment situations are handled in a sensitive and confidential manner.

Employees and program participants are responsible for:

· Treating others with respect

· Informing the House Manager or Owners of any harassment

· Collaborating in a harassment investigation and respecting the confidentiality of the investigation process.

Employees and program participants can expect:

· To be treated with respect;

· That reported harassment will be dealt with in a timely, confidential and effective manner;

· To have their rights to a fair process and their confidentiality respected during a harassment investigation; and

· To be protected against retaliation for reporting harassment or cooperating with a harassment investigation

5. PROCEDURE

Creating an environment free of discrimination and harassment is everyone’s responsibility. If you observe or believe that you are a victim of discrimination, sexual harassment, or any other form of harassment at The Nova Residence, on premises, in the course of the company’s business or any other activity sponsored by the Company, you must immediately report it to one of the following:

· The House Manager

· The Owner

· Submitting a request online via the Contact Us page of www.thenovaresidence.com

An employee or program participant may file a harassment complaint by any means above. The complaint may be verbal or in writing. If the complaint is made verbally, the person receiving the complaint will record the details provided. The complainant should be prepared to provide details such as what happened, when it happened, where it happened, how often and who else was present (if applicable).

Complaints should be made as soon as possible but no later than within one year of the last incident of perceived harassment, unless there are circumstances that prevented the complainant from doing so.

6. HOW COMPLAINTS WILL BE HANDLED

Any claims of discrimination or harassment will be investigated promptly and discreetly. All complaints are treated with sensitivity and are kept as confidential as possible. We will never disclose who made a complaint to anyone or give out information that may help others identify that person. An appropriate disciplinary action will be taken to eliminate inappropriate behavior.

In addition, you are not required to report your complaint to the person who is the subject of the complaint. For example, if your complaint is against the House Manager, you can make your complaint on the website at www.thenovaresidence.com or directly to the owners. However, if someone at The Nova Residence premises, in the course of the company’s business or in a company-sponsored function engages in conduct that makes you feel uncomfortable, we encourage you to tell them that the conduct is unwelcome, that you find it offensive and that you ask that it stop immediately.

The Nova Residence will promptly investigate complaints. You must cooperate fully in such investigations. If warranted, the Company will take appropriate corrective action, up to and including termination of employment or discharge from the home.

The Company prohibits any form of reprisal against a plaintiff for reporting discrimination or harassment or for participating in an investigation of a complaint of discrimination or harassment. If you believe you have been subject to reprisal, you can use any of the resources described above to report your concern.

Chore Schedule

The following chores/cleaning schedule must be followed by each home. Specific tasks to be assigned by the House Manager. Additional tasks may be added as deemed necessary.

Daily:

· Make beds daily

· Wash and put away all dishes

· Sanitize kitchen counters

· Sweep kitchen floors

· Take out trash (kitchen, bathrooms, bedrooms, etc)

· Raking leaves/shoveling snow as season requires

Weekly:

· Clean/sanitize bathrooms including tub, shower walls/enclosures, sinks, counters and floors

· Wash all bedding and towels

· Take trash to street on pick-up day

· Mop kitchen, living spaces, dining room, hallways and bedrooms

· Dust

· Clean out ashtrays and pick up any cigarette butts throughout property

Monthly:

· Clean baseboards

· Clean window sills

· Dust blinds

Semi-annually – April and October

· Change air filters

· Wash inside and outside windows

Seasonally as needed:

· Shovel driveway and walkways and lay ice melt as needed

· Mow and clean up yard

· Water yard

Complaint Policy

This document provides guidelines for resolution and the treatment of complaints made to The Nova Residence management.

1. POLICY STATEMENT

At The Nova Residence, we believe that if a program participant wishes to file a complaint or express dissatisfaction, it should be easy for them to do so. It is The Nova Residence’s policy to receive complaints and consider them as an opportunity to learn, adapt, improve and better service.

In addition, a quick resolution of complaints, in a way that respects and values the person’s feedback, can be one of the most important factors in recovering the person’s confidence in the company. A responsive, efficient, effective and fair complaint management system can assist an organization to achieve this.

2. PURPOSE

This policy is intended to ensure that The Nova Residence handles complaints fairly, efficiently, and effectively. The Company’s objective is to ensure that its complaints procedure is properly and effectively implemented, and that complainants feel confident that their complaints and worries are listed to and acted upon promptly and equitably.

Our complaint management system aims to:

· Allow us to respond to questions raised by people who file complaints in a timely and cost-effective manner

· Increase confidence in our administrative process, and

· Provide information that we can use to improve the quality of our services, personnel and complaint handling.

This policy provides guidance to our staff and to individuals who wish to file a complaint about the key principals and concepts of our complaint management system.

3. SCOPE

This policy applies to all staff receiving or managing complaints made to or about us, regarding our services, staff and complaint handling.

4. WHAT IS A COMPLAINT

A complaint is any expression of dissatisfaction about the services offered by The Nova Residence, its staff or the action or lack of action taken regarding operations, facilities or services provided by The Nova Residence or by a person or body acting on behalf of The Nova Residence.

A formal complaint means a complaint that has not been successfully resolved through the Complaint Management Process as outlined in this policy. The complainant has chosen to formalize the complaint by completing a Complaint Form.

An informal complaint means a complaint that has been received by The Nova Residence by telephone, email, regular mail, online or in-person, which has not been submitted on a Complaint Form.

All non-anonymous complaints filed necessitate a response.

5. COMPLAINT MANAGEMENT SYSTEM

Oral Complaints

· The Nova Residence employee who receives a verbal complaint should try to resolve the issue immediately if possible. If staff cannot resolve the problem immediately, they should offer to refer it to the Complaint Manager for resolution. The complaints manager will be the named person who deals with the complaint through the process. When staff or managers receive an oral complaint, they should listen sincerely to the concern(s) raised by the complainant. Any contact with the complainant must be polite, courteous and sympathetic. At all times, staff and managers must remain calm and respectful.

· After discussing the problem, each staff member handling the complaint should suggest an action plan to resolve the complaint. If the action plan is acceptable, the staff member should clarify the agreement with the complainant and agree on a way in which the results of the complaint will be communicated to the complainant (i.e., by another meeting, an email, a letter, a phone call etc.)

· If the proposed action plan is not acceptable to the complainant, the staff member should ask the complainant to make his or her complaint in writing to The Nova Residence and provide a copy of the procedure and complaint form to be completed.

· In both situations, details of the complaint should be recorded on a complaint form.

Written Complaints

· When a complaint is received in writing, it must be forwarded to the designated Complaint Manager, who must send acknowledgement of receipt within 5 business days in order to establish a relationship of confidence with the person who filed the complaint.

· If necessary, further clarification should be obtained from the complainant.

· After receiving the complaint letter, a copy of this complaint procedure must be given to the complainant. Clearly explain to the complainant the complaint process, the time it can take and set realistic expectations.

· Immediately upon receipt of the complaint, The Nova Residence will launch an investigation and within 10 business days should be in a position to provide a full explanation to the complainant, either in writing or by arranging a meeting with the individuals concerned.

· All relevant information about the complaint must be recorded and kept as simple and accurate as possible.

· If the issues are too complex for the investigation to be completed within 10 business days, the complainant should be informed of any delays.

· If a meeting is organized, the complainant may, if he or she wishes, be accompanied by a friend, relative or representative.

· At the meeting, a detailed explanation of the results of the investigation should be given and an apology should be made if deemed appropriate. This allows The Nova Residence an opportunity to show the complainant that the matter has been taken seriously and has been thoroughly investigated.

· Finally, the results of the meeting should be documented and any weaknesses in The Nova Residence’s procedures should be identified and modified as needed.

A copy of the complaint form can be found online at our website www.thenovaresidence.com

Conduct Policy

All staff and program participants must abide by the following Conduct Policy

1. All persons and common areas in housing are to be treated with respect, cleanliness, and consideration with regard to sharing.

2. Be kind and considerate when speaking to other program participants and staff. Be friendly, courteous to neighbors.

3. Bed shall be made daily. All personal areas and belongings to be picked up and put away before leaving each day. Further agree to complete shared house chores as posted on the Chore Schedule or assigned by the House Manager.

4. No personal oversized TVs, speakers, refrigerators, microwaves, coffee pots, heaters, furniture, candles or excessive property are permitted.

5. Any program participant caught stealing will be immediately discharged from housing. Suspected program participant(s) may be moved.

6. Weekly supplies are a privilege and not part of the housing fee. Donations are to be shared respectfully.

7. Food shall only be consumed in dining area and kitchen. Food shall not be consumed or stored in the bedrooms.

8. Shoes should not be worn on any of the furniture including couches, tables and beds.

9. Wi-Fi, Internet, Cable TV, and Phone service is a privilege. Abuse of data usage, illegal downloading, or calls to 411 information will cause interruption in services. Privileges can be suspended at management’s discretion.

10. Participants must be mindful of the need of all program participants to access the computer and shall limit their usage as such. Computer usage must be limited to employment searches, emails, and applications for services such as Medicaid, Social Security etc. No streaming of videos, social media, or adult sites. Privileges can be suspended at management’s discretion.

11. Absolutely no tampering with any technology equipment throughout the home including computers, printers, and cameras. Any person found tampering with any equipment shall face disciplinary action up to and including immediate discharge from the program.

12. Suspicion of drugs/alcohol use in a house should be reported immediately (24/7) to the House Manager, After Hours Service Provider or Management. You may also leave an anonymous tip via our website www.thenovaresidence.com. Please request “a test of the house.” Your call will remain Anonymous.

13. BUNK BED POLICY – If you are assigned to a bunk-bed, and one bunk is unoccupied, the unoccupied bunk is not to be used as storage for any personal items. You agree to take full responsibility for any belongings found in/around the bunk bed when you are the sole occupant.

14. No borrowing of money from other program participants or staff. No borrowing cigarettes, food or belongings. Health & Welfare will provide emergency food stamp card with picture ID. St. Vincent de Paul 208-331-2208 will provide clothing vouchers, bus passes and bikes when funds are available.

15. Upon move out, program participants are responsible for clearing out ALL personal effects as well as thoroughly cleaning the bedroom areas including under and behind the furniture, the walls, floor, dresser, window and closet. Clean out your area in the refrigerator/freezer, the dry goods and bathroom supply spaces. You are responsible for completing your assigned chore before moving from the house.

Drug Testing Policy

1. POLICY STATEMENT

At The Nova Residence, we believe that a clean, safe and sober living environment is paramount in fostering a lasting healthy and sober lifestyle. As such, as a staff member or program participant of The Nova Residence, you will be required to abide by this policy.

2. PURPOSE

This policy is intended to ensure that program participants and staff of The Nova Residence have clear, concise guidance regarding the occurrence, cost, and consequences of drug testing at The Nova Residence.

3. SCOPE

This policy applies to all program participants and staff. This policy further applies to all behavior at any Nova Residence premises and/or related in any way to work, including off-site meetings, trainings and business trips.

4. PROCEDURE

Staff and program participants must adhere to and agree to the following:

· Absolutely no alcohol and/or drugs on or off the premises. Narcotics and controlled substances are not allowed. We practice TOTAL ABSTINENCE from all mind-altering substances, legal or illegal including Spice, Kratom, Bath Salts and designer drugs. Medication-Assisted Treatment programs are allowed and must be reported to staff prior to use of the medication.

· Curfew violators will be required to pass a drug test upon return. Urinalysis fee is $35. For program participants on probation/parole, PO will be notified.

· Submit to random drug/alcohol testing. If unwilling or unable to produce a sample for drug testing, staff or program participant agrees to leave premises immediately and not return until a negative test result can be provided. For program participants on probation/parole, PO will be notified.

· Suspicion of drugs/alcohol use in a house should be reported immediately (24/7) to the House Manager, After Hours Service Provider or Management at (888) NOVA-208 or via our website using the Anonymous Reporting feature at www.thenovaresidence.com . Please request “a test of the house.” Your call will remain Anonymous.

· Failure to provide a negative test, will result in disciplinary action up to and/or including immediate discharge from the program. For program participants on probation/parole, PO will be notified.

Payment Policy

Payment must be made via electronic payment, money order or cashier’s check. For your convenience, you may also pay online via paypal at paypal.me/novaresidence or on our website www.thenovaresidence.com . No personal checks will be accepted. All payments are non-refundable.

Program Fee Schedule: $500 for 30 days, $250 for 14 days, Upon exception only, a $150 weekly rate may be accepted.

If paying program fees on the 1st of the month the monthly program fee is $500/Month

After the first month, if you opt to pay on the 1st of every month, program fees will be prorated at a discounted daily rate of $15/day through the end of the month. Program fees would then be $500/month, due on the 1st.

Ex: Initial Move in Date of February 15. Program Fee Expiration date is March 15. Program Fee date would be March 16. We will prorate 16 days (March 16 thru March 31st) of program fees at $15/day for a total of $240. Next program fee due date would be April 1st and on the 1st of every subsequent month in the amount of $500.

All payments are Non-Refundable.

A late fee of $5 per day will be assessed. After 5 days of non-payment, we reserve the right to process an immediate discharge.

If The Nova Residence is an approved BPA provider you can call 1-800-922-3406 for eligibility. If you are approved for funding, call our main office at (888) NOVA-208 to verify we have received Authorization. BPA Clients pay $50/monthly program fee for utilities.

If The Nova Residence has to pack & store personal belongings after a move out, a $25 fee will be charged. Belongings will be donated after 30 days if belongings have not been picked up after 30 calendar days.

There is no required minimum length of stay beyond the first month. Maximum length of stay to be 90 days. Exceptions to maximum length of stay may be granted based on bed availability and conduct history.

It is the responsibility of the program participant to know when the program fee is due and should be paid before 10:00 pm on the day due. Cash payments are not accepted. Please pay via cashier’s check, money order, paypal.me/novaresidence or online at www.thenovaresidence.com

Transportation Policy

1. POLICY STATEMENT

At The Nova Residence, we recognize that our program participants may have no or limited access to transportation during their stay. We further recognize the importance of having a means of transportation to access vital services including government and/or judicial appointments, medical appointments and support programs.

2. PURPOSE

This policy is intended to provide guidance on access to transportation provided by The Nova Residence

3. SCOPE

This policy applies to all current program participants.

4. TRANSPORTATION

Public Access Transportation

Idaho Medicaid contracts with MTM (Medical Transportation Management, Inc) to manage a statewide network of transportation providers for Idaho’s Non-Emergency Medical Transportation (NEMT). You may contact MTM directly to request transportation by calling 1-877-503-1261 or by visiting MTM’s Medicaid Transportation website www.mtm-inc.net/idaho/members/ .

Routine trips can be scheduled Monday through Friday from 8 am to 6 pm.

The Nova Residence Sponsored Transportation

As public transportation access remains limited in the areas surrounding The Nova Residence’s sober living homes, transportation will be provided in the following limited circumstances:

Transportation to and from the following appointments are eligible for transportation provided by The Nova Residence:

· Emergency Medical

· Judicial

· Government (DMV, Medicaid, Probation/Parole)

Transportation may be provided by the following means:

House Manager

Under certain circumstances, the House Manager may, upon prior written approval from the Owner, provide limited transportation for program participants to attend appointments.

Rideshare and Taxi Service

As rideshare and taxis become more available in the areas surrounding The Nova Residence, our program participants will have access to sponsored transportation. A written request must be submitted for approval. Requests must be received at least 48 hours prior to appointment to allow time for scheduling.

Requests must be made online at www.thenovaresidence.com/guest-resources using the Transportation Request form.

Bicycle

As the location allows, The Nova Residence will provide house bicycles that can be used for transportation that is nearby the home. Bicycle usage must be scheduled with the House Manager and noted on the Bike Check-In/Check-Out Sheet. Upon completion, please take a picture and text or email to info@thenovaresidence.com. Abuse or destruction of the bicycles, or failure to return a bicycle may result in consequences per the House Conduct policy. Privileges can be suspended at management’s discretion.

5. COMPLIANCE

When utilizing transportation provided by The Nova Residence, proof of attendance of the proposed meeting will be required upon return to the home. Failure to provide documentation supporting attendance may result in loss of transportation privileges or further consequences up to and including immediate discharge from the program.

RELEASE OF LIABILITY

This release of liability (release) is executed by the undersigned (guest) in favor of The Nova Residence, a privately run safe and sober facility and its directors, officers, employees, volunteers, landlord and agents.

• RELEASE: Undersigned hereby waives, releases, and discharges The Nova Residence from ANY and ALL liability claims or demands of ANY KIND or nature whatsoever, either in law or in equity, that may arise from any services provided by The Nova Residence. Undersigned further releases from demand or damage that guest may now or in the future have with respect to any bodily injury, personal injury, illness, death, property loss, or property damage, even if caused in whole or part by the negligence of The Nova Residence.

• ASSUMPTION OF RISK: Program Participant understands that there will be other persons at facility from time to time and that Program Participant may be in proximity or contact with such other persons while at The Nova Residence. Program Participant acknowledges that such other persons present risk of potential bodily injury, personal injury, illness, death and property loss or property damage, by way of example and without limitation, such other persons may have contagious disease, may have mental illness, may be reckless, may be dishonest, may steal, may have weapons, may have drugs, may have violent tendencies or history of violence toward himself or others, may make carless or hurtful or defamatory statements. Program Participant fully understands this and will take precautions to protect themself from the foregoing risks. Program Participant waives and releases The Nova Residence from any and all liability, claims and demands of ANY kind or nature whatsoever, either in law or in equity, that may arise from or be related to foregoing risks, even if such risks were in whole or part by negligence of The Nova Residence.

• PHOTOGRAPHIC RELEASE: Program Participant hereby gives permission to The Nova Residence to take and use photographic images, video recordings and audio recordings of Program Participant as The Nova Residence desires. Program Participant hereby disclaims any right to such images and recordings including, but not limited to any royalties, proceeds or other benefits derived from such photographs or recordings.

• CONSENT TO MEDICAL TREATMENT: As a Program Participant of The Nova Residence, you give permission in the event needed, The Nova Residence may call the proper officials (emergency services) to transport you to a medical facility for any care you may need that arises.

This release is intended to be as broad and inclusive as permitted by law. If any clause or provision of the release is held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not affect the remaining provisions of this release which shall continue to be fully enforceable.

Program participant has executed this release as of the day and year set forth below.

Program Participant Name: Client first name Client last name Date: Text field

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.

Signature: Signature

RELEASE OF PERSONAL PROPERTY

Name: Client first name Client last name Date: Text field

Please let this letter serve as confirmation that the person(s) listed below are authorized to pick up my personal belongings in the event I am discharged from The Nova Residence and unable to personally pick up any remaining personal property.

Name (s): Text field

Upon pick up, aforementioned authorized person will be required to provide a photo ID to verify their identity.

I understand and agree that a $25 move out fee will be required prior to release of my personal belongings in the event The Nova Residence packs and/or stores my belongings upon my departure. Payment shall be made by money order made payable to The Nova Residence or online at www.paypal.me/novaresidence prior to or at time of release of property.

Failure to provide payment and pick up personal belongings within 30 days of program discharge will result in all items being donated.

Date: Text field Resident Signature Signature

VERIFICATION OF RELEASE: Personal items were released to: __________________________________

Staff Signature Date

Signature - Person Property Released To Date

CONSENT FORM

CLIENTS RELEASE OF INFORMATION CONSENT

Notice to Clients: The Nova Residence will be able to help you better with resolving of issues you may have with the following listed Items. Signing this form gives our professionals the right to share information with corresponding agencies on your behalf. If you decline to sign this form, your confidential information can be shared to the extent State law allows.

CONSENT: I allow The Nova Residence’s housing specialist to use my confidential information to provide, and coordinate services, treatment, and benefits for me or for other purposes authorized by law. I allow The Nova Residence and the below listed agencies, providers, or persons to use my confidential information and disclose it to each other for these purposes. Information may be shared verbally or by computer, data transfer, mail, or hand delivery.

Dropdown Employment Security Dept.

Dropdown Social Security Administration

Yes (Required) - Department of Corrections

Dropdown Child Support Enforcement

Dropdown Health Care Providers

Dropdown Mental Health Providers

Dropdown Chemical Dependency Providers

Dropdown Housing Program Providers

Dropdown Department Social Health Services

Dropdown Colleges and Education Providers

Dropdown Attached Lists

Dropdown Others: Text field

Additional Consent: If your confidential records include any of the following information, you must also complete this section to include these records. I allow The Nova Residence to share the following records

ð Mental Health HIV/AIDS and STD test results, diagnosis, or treatment Chemical Dependency (CD) services

This consent is valid for one year as long as The Nova Residence needs records, or until Text field

I may revoke or withdraw this consent at any time in writing, but that will not affect any information already shared. I understand that records shared under this consent may no longer be protected under the law set. A copy of this form is valid to give my permission to share records.

Date Signature Signature

NOTICE TO RECIPIENTS OF INFORMATION: If you have received information related to drug or alcohol abuse by the client, you must include the following statement when further disclosing information as required by 42 CFR 2.32:

This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR part w. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.

PROGRAM HANDBOOK ACKNOWLEDGEMENT

I confirm that I have received a copy of the Housing Handbook including the following:

House Rules

Anti-Harassment Policy

Chore Schedule

Complaint Policy

Complaint Form

Conduct Policy

Drug Testing Policy

Payment Policy

Transportation Policy

Release of Liability

Release of Property

Consent Form

I confirm that I will abide by all policies above as well as any forthcoming policy changes and new policies as they arise.

Name: Client first name Client last name

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