Women's Application and Sober Housing Agreement for Stronger Sober House

Women's Application and Sober Housing Agreement effective 11/1/24

 First Name Client first name Middle InitialClient middle name Last Name Client last name

Nickname:  Client nickname

Paid Upfront:  Deposit:  $150 |  Program Fee:  $700/mo  or $850/mo (single room)   ***Fee/Balance after applying any housing credit is due upfront***

ACH:  Rtg# 291075116 Acct# 101000000849468 | Cashapp/Venmo:  $strongersoberhouse  |  Paypal:  @strongersober | Square

Birthdate: Client birthdate  Desired Move-in Date:  Date

Email:  Client email SSN: SSN Phone: Client phone

Drug of Choice:  Client substances of choice

Sober Date: RecoveryHistory (Relapse Date optional)

Outpatient Program: Text field   Date of Intake:  Date  Amount of Housing Stipend:  Text field

Are you on Probation or Parole or are pending? Dropdown

What is your Mental Health Diagnosis, if any? Text field

Check All Applicable:

Checkboxes

Have you experienced Homelessness in the last 10 years: 

Radio buttons

Referred by: Text field

Gender:Client gender

Race:Client race

Ethnicity:  Client ethnicity

Marital Status:Client marital status

Veteran:Client veteran status

Prescribed Medication(s): Everything is optional except name Medication 

Emergency Contact:  Contact

Emergency Contact (phone):  Text field

Emergency Plan:  Text field

Employer:  Text field 

How Long?  Text field

Sponsor:  Client sponsor 

Home Meeting: (location/day/time)  Text field

Any thing else we need to know?  Client notes

If application is accepted, I assume the obligations of residency and agree to the following conditions:

  1. Any use of alcohol or drugs will result in immediately being asked to leave and loss of sober deposit.
  2. Any destruction of property will result in prosecution and immediately being asked to leave.
  3. Failure to follow house rules and expectations may result in being asked to leave.
  4. Program fee is due the 1st of each month; failure to pay Program fee by the 5th of the month will result in a $35 late fee and may result in immediately being asked to leave.
  5. A sober /damage deposit will be required before residency begins.
  6. Sober/damage deposit will be returned within 30 days of departure if entitled.  If your deposit or fee is paid by a deposit assistance program or outside organization, you will not be entitled to those funds.
  7. At least a 30-day notice is required from house member to end Housing Agreement (as long as you have completed or will have completed the 4-month commitment)
  8. Any false information can result in immediately being asked to leave. 

By signing below, I am giving a release to speak with my probation officer and/or emergency contact. 

If I drink/use or leave before my 4-month commitment is up or am asked to leave for not following house rules and expectations, I will lose my deposit and program fee for that month.  No Refunds.  Initials: Initials Text field

This is a Housing Agreement, not a Lease: By signing this agreement, you understand that residency in this sober home is contingent upon adherence to the house rules and participation in the program. This agreement is not a rental lease, and rental rights do not apply. As such, residents may be asked to leave the premises if they fail to comply with the rules or the expectations of the sober living environment. Initials Initials Text field

Signature: Signature 

Date:  Date

House Expectations

PRIMARY RULES

  1. NO use of Alcohol or any other mood-altering substances.
  2. NO Sexual activity or exclusive relationships with other residents.
  3. NO violence or threats of Violence.
  4. NO Males/partners/boyfriends allowed on Porch only and to carry stuff in and out of the house.
  5. DON’T break curfew, 12am (Sunday-Thursday nights) and 1am Friday and Saturday night.
  6. Women and children allowed in the house until 9pm.
  7. Doors to remain locked at all times for everyone’s safety.

RULES ON PRINCIPLES OF RECOVERY

Residents are required to practice the Principles of Recovery:

  1. Participate in Mandatory House meetings and any special house meetings called at any time.
  2. Actively participate in 12 Step meetings.
  3. Have a sponsor, work closely with them, meet with them face to face at least 1 time a week. If you do not have one, get one within 60 days.
  4. Attend 3 meetings weekly, 12 Step.
  5. Have a NA or AA service or commitment.

RULES & REQUIREMENTS

  1. You will be expected to remain a resident in the house for a minimum of 4 months. If you choose to leave, a 30-day notice must be given.
  2. Complete your chores and keep the house clean (see chore section).
  3. Residents must REPORT any knowledge or suspicion of using drugs or alcohol by anyone living in the Harrison House and failure to do so could result in your being asked to vacate the house.
  4. Overnights:
    1. Send request to House Manager 24 hours in advance with where and when you will return.
    2. Overnight pass allowed after 30 days and weekend passes allowed after 60 days.
  5. Be Sober
    1. To ensure sobriety you may be asked to take a UA, breathalyzer or any-other-type of test to verify that you have not been using drugs or alcohol. (If a blood or urine sample is needed, you are responsible for the payment). If you refuse to take any of the tests, you will have to leave the house IMMEDIATELY.
    2. If you are found to be under the influence of drugs or alcohol:
      1. You must leave the house immediately.
      2. The Senior Peer will help determine the safest & appropriate place for you to go.
      3. If you refuse help and become uncooperative in any way or attempt to drive under the influence, the police will be called.
      4. The door code will be change.
      5. You will need to speak with the House Manager before coming back to the house.

RULES AND INFORMATION ON CHORES

  1. Every resident is assigned chores and expected to actively be a part of keeping this house clean.
  2. Read the binder on the steps for cleaning each area.
  3. Complete the chore you are assigned and check off on the Chore checklist.
  4. Participate in the Deep Cleans that are scheduled ONCE a month during the same time as the regular House Meeting unless otherwise noted.
  5. Familiarize each chore on the Board posted on the wall in the kitchen
    1. House chores will rotate every 2 weeks to ensure cleaning responsibilities are delegated in a fair manner.
    2. It is expected that each resident thoroughly cleans their assigned area of the house ONCE per week and continues to maintain that area throughout the week.
    3. If you miss your dish day, you will have dish day for the rest of the week. If you have a pre-approved overnight, make sure you have asked someone to cover your day if you have a dish day during your absence.
  6. Follow the Dish Rules
    1. Dishes are not allowed in the bedrooms.
    2. Rinse dishes and silverware before putting them in the dishwasher.
  7. Follow Bathroom Rules:
    1. Clean the shower drain after showering.
    2. Do hair drying, curling and brushing in your room.
  8. Car
    1. Do not park on neighbor’s property or blocking their driveway.
    2. You must have a Driver’s License, current auto tabs and proof of insurance.
    3. One car per house member and car must be in working order.
  9. No Storage in the House
    1. Bring only what fits in your dresser/closet/under bed/approximately 2-3 bags.
    2. Excessive items will be decided by House Manager/Owner.
    3. If you need to store a box or 2, storage starts at $30/month.

Resident Agreement and Acknowledgment

I, the undersigned, have read and understand the Harrison House Rules. I agree to follow these rules and commit to upholding the values of recovery, community, and support while living at Harrison House. I understand that failure to comply with these rules may result in consequences, including being asked to leave the house. I also acknowledge that all house rules are subject to change at the discretion of Harrison House staff, and I will be notified of any updates. Compliance with the updated rules is required for continued residency.

  1. If I drink or use drugs, I will lose my sober deposit and that month’s program fee will not be returned. Initials Initials Text field
  2. If I do not complete my 4-month commitment I will lose my sober deposit.  Initials Initials Text field
  3. If I do not give a 30-day notice that I am leaving after my 4-month commitment I will lose my sober deposit.  Initials Initials Text field
  4. Any violence or threat of violence will result in immediate termination and loss of sober deposit and fees.  Initials Initials Text field

Print Name:  Text field

Signature:  Signature

Date: Date

Sober Home Resident Bill of Rights

As a resident of this sober home you have rights that the residence staff will safeguard during your stay.  You have a right to:

  1. An environment that supports your recovery.
  2. An environment that is safe and free from alcohol and other illicit drugs or substances.
  3. Be free from physical and verbal abuse, neglect, financial exploitation, and all forms of maltreatment covered under the Vulnerable Adults Act, sections 626.557 to 626.5572
  4. Be notified if the home supports Medication Assisted Treatment (MAT).
  5. Be treated with dignity and respect and to have personal property treated with respect.
  6. Have personal, financial, and medical information kept private and to be advised of the sober home’s policies and procedures regarding disclosure of such information.
  7. Assert these rights personally or have them asserted by the individual’s representative or by anyone on behalf of the individual without retaliation.
  8. Have your spiritual, cultural, and religious beliefs respected.
  9. Be actively involved in setting your recovery goals and length of stay.
  10. All good faith efforts to protect your privacy and anonymity throughout your stay.
  11. Have access, while living in the residence, to other community-based support services as needed.
  12. Be referred to appropriate services upon leaving the residence if necessary.
  13. Retain personal property that does not jeopardize your or others’ safety or health.
  14. Be provided with the name, address, and telephone number of the ombudsman for mental health, substance use disorder, and developmental disabilities and information about the right to file a complaint.
  15. File a complaint to the owner/operator or other oversight organization (e.g., MASH) without fear of retaliation.1
  16. Be fully informed before changes occur in these rights and responsibilities as well as to changes in policies and procedures should they occur.
  17. Not to be required to perform services for the residence, which are not included in the usual expectations for all residents.
  18. Be fully informed of any fees that you may be charged and if a third party pays any fees on your behalf.
  19. Have at least one emergency contact kept on file by the home to reach out to in the case of an emergency, discharge, or death.

I have been informed of my rights as listed above.

Print Name: Text field

Signed: Signature Date: Date

1 To file a complaint, please fill out the Complaint Form found on the MASH Website.

For more information, and any other questions or concerns you may have, please contact us at: Phone: (612) 223-6274 Website: https://mnsoberhomes.org/