One Step

1-BL Application-SSH

Resident Intake and Agreements

READ CAREFULLY
Read this agreement and the house rules carefully. You are expected to know and follow ALL rules in order to remain in the house.

Violations of house rules result in immediate discharge, with or without warning, as determined by management. Management’s decision regarding violations, warnings, and discharge is final.

You must abide by ALL house rules. Some important rules you are agreeing to follow before you apply include (not limited to):

Provide date and time of Completed or Scheduled IOP before or within 24 hours of moving in:
1. Have a Signed ROI for Stronger Sober House
2. Have your IOP counselor email strongersoberhouse@gmail.com or Fax 651-262-0388 the Comp Assessement with Score of 4 on Dimensions 4, 5 or 6.
Be Sober and pass UA on Move-in Date and Remain sober at all times
Maintaining a working, active phone that will be used for required communication
Following daily curfew (Sun–Thur 10pm; Fri–Sat 12am) and completing daily check-in every day
Cleaning up after myself and completing all daily and weekly chores before the Sunday night meeting; dishes, bedroom, and shared spaces will be kept clean at all times
Attending 9 or more hours per week of in-person (not telehealth) treatment/IOP and remaining in good standing with my treatment provider; missed unexcused required group attendance will result in immediate discharge from the house
Attending the mandatory Sunday house meeting (7pm or 8pm depending on house)
Joining WhatsApp before move-in and being responsible for house information
Following overnight rules: no overnights in the first 30 days; after 30 days, a maximum of 2 per month with 24-hour advance notice
Completing 30 hours minimum per week of productive recovery activities (treatment, work, recovery meetings, volunteering, etc.)
Bringing only 3–4 large bags of clothing or belongings into the home; excess items will be returned for off-site storage
Must be Board and Lodging eligible at all times with a Comp Assessment from IOP and active MA/PMI number

I have read, understand, and agree to comply with all house rules, policies, and program requirements, whether listed above or elsewhere in this agreement, and acknowledge that violations result in immediate discharge as determined by management.

Initials:Initials Text field

RESIDENT INFORMATION
General
Sobriety:
Last date of Use: Date
Have you been Sober for 30 days for more: Checkboxes
Legal First Name Client first name
Middle Initial Client middle name
Legal Last Name Client last name

Nickname: Client nickname

Birthdate: Client birthdate

Social Security Number: SSN
Cell Phone (this number will be used for WhatsApp and OneStep Recovery, make sure this is right): Client phone
Email: Client email
Planned Move-In Date: Date
Name of Current Location (treatment center, sober home, shelter, etc.): Text field
Are you being asked to leave your current sober home? Dropdown
Which Sober Home and Why are you being asked to Leave? Text field

Treatment Provider
Where are you attending IOP? Text field How many hours of IOP per week? Text field
When was or will be your intake date Date
--If you still have to schedule intake, text us your intake date and IOP provider. You will be discharged immediately if you miss intake or do not provide intake information.
Current Treatment Provider: Text field
Name of Counselor at IOP: Text field Phone number of counselor Text field Email of counselor Text field
Referred By Client Referred By

Check All Applicable:

Checkboxes

Have you experienced Homelessness in the last 10 years:

Radio buttonsLivingArrangementHistory

Gender: Client gender

Race: Client race

Ethnicity: Client ethnicity

Marital Status: Client marital status

Veteran: Client veteran status

Insurance Information:  If you are unable to provide this information at the time of request, you will have 24 hours to obtain and submit it. Failure to do so will result in non-compliance with Stronger Sober House Policies and will lead to discharge from the program.
MHCP # or PMI # (8-digits)Text field
Insurance Provider:  Text field
Insurance Plan:  Text field
Insurance Group ID: Text field
Insurance Policy#:  Text field
Other Insurance Information: Text field

Criminal History

Are you currently involved with the criminal justice system (probation, parole, ISR, pending charges, or court supervision)?: Dropdown
Have you ever been charged with or convicted of arson?: Dropdown
Are you aware of any active warrants for your arrest? Dropdown

Are you currently on probation, parole, or Intensive Supervised Release (ISR)? Dropdown
Start Date and End Date: Text field
Probation/Parole/ISR (Name and Phone): Text field

CheckboxesI authorize Stronger Sober House to communicate with my probation/parole officer and other supervision or treatment contacts regarding my residency, compliance, attendance, and discharge if needed.

Are you a Sex Offender? Dropdown
Do you have to Register as a Sex Offender? Dropdown
Are you here on a civil commitment?  Dropdown
Describe any pending court dates, warrants, probation/parole requirements, or legal issues that could require you to leave the house suddenly:  Text field
Court Date:  Text field

Is there any reason you may be incarcerated or detained within the next 90 days? Dropdown

Medical History

Do you have any medical conditions that would prevent from living independently or prevent you from using stairs or completing daily and weekly chores? If none, enter No. Text field
Do you have Medical Conditions? Dropdown
List All Medical Conditions: Text field
What is your Mental Health Diagnosis, if any? Text field

Drug(s) of Choice (add multiple by clicking in box and selecting different options: Client substances of choice

Medications Please list any preventive medications you are currently prescribed. Be sure to check the boxes for any of the following, if applicable: controlled substances, medications used in Medically Assisted Treatment (MAT), and authorized medical cannabis.

List Preventative Medications: Text field

Controlled Substance(s):
Checkboxes
Medical Assisted Treatment:
Checkboxes
Medical Cannabis:  Dropdown

Emergency Contacts

If I leave the sober house and don’t pick up my belongings within 7 days, I give permission for the house to contact my listed emergency contacts—or another person I designate—to retrieve my belongings for me.

List the name and phone number of the designated person to retrieve your belongings, if not using emergency contacts OR type “Emergency” if there is no one else): Text field

1st Emergency Contact (name and relationship to you): Text field
1st Emergency Contact (phone): Text field

2nd Emergency Contact (name and relationship to you): Text field
2nd Emergency Contact (phone): Text field

Any thing else we need to know about you or your application?

Paragraph

Declaration
I affirm that all information provided above is true and accurate to the best of my knowledge. By signing below, I confirm that I have read and understand the policies, procedures, rules, and regulations. My signature signifies my agreement to adhere to these rules and regulations and to comply with the policies and procedures. Additionally, I acknowledge that I understand I am not entitled to tenant laws, as this is a sober living home, and my residency agreement is conditional and may be terminated at any time.

Signature

Release of Liability and Hold Harmless Agreement

In consideration of receiving housing services from Stronger Sober House LLC (“Company”), I hereby release and discharge the Company and its officers, employees, agents, and representatives (“Releasees”) from all liability, claims, demands, disputes, or causes of action—known or unknown—arising from any injury, death, or property damage sustained by me or my family while on Company premises or participating in the housing program, whether caused by the negligence of the Releasees or otherwise.

I acknowledge and voluntarily assume all risks associated with sober living, including those arising from travel, shared housing, or unforeseen events, and accept full responsibility for any resulting harm or loss.

I agree to indemnify and hold harmless the Releasees from any and all claims, liabilities, costs, and attorney fees arising from my presence or participation, regardless of cause.

This Agreement shall bind me, my spouse, family, heirs, estate, legal representatives, and assigns, and be governed by the laws of Minnesota or the state in which the Company operates.

By signing below, I affirm that I have read, understand, and voluntarily agree to the terms herein, that no oral promises have been made, that I am at least 18 years old, legally competent, and intend for this document to be fully binding.

Signature

Sober Living Agreement
This is a legally binding document. Please read it carefully.

I understand that the sober living home to which I am applying for residency operates in compliance with the Federal Anti-Drug Abuse Act of 1988, P.L. 100-690, as amended, which requires residents to:

a) Refrain from using any alcohol or illegal mood-altering substances.
b) Face expulsion for violating the prohibition on alcohol or illegal substances.
c) Participate in democratic decision-making within the group, where appropriate, including decisions regarding inclusion and expulsion from the group.

Initials Text field I agree to follow ALL house rules, including:

Abiding by daily curfew (Sun-Thur 10pm, Fri-Sat 12am) and completing daily check-in and check-out on the OneStep Recovery App every day, and being fully set up on the app before move-in;
Cleaning up after myself and completing daily/weekly chores;
Attending 9 or more hours of in-person treatment/IOP every week (telehealth is not allowed) and staying in good standing with my treatment provider. Discharge from treatment means immediate discharge from the house;
Attending the mandatory Sunday house meeting (6pm, 7pm, or 8pm depending on house);
Joining and being active on WhatsApp before move-in;
Following overnight rules: no overnights in the first 30 days, and a maximum of 2 per month after that; minimum 24 hours advance notice required for approval.
Completing 30 hours per week of productive recovery activities (treatment, work, recovery meetings, volunteering, etc.).
Bringing 3-4 large bags of clothes or belongings with you into the home and your shared bedroom space. Do not bring more. Anything extra will be returned for you to toss.

Initials Text fieldI understand that housing under Free Standing Room and Board (FSRB) at Stronger Sober House LLC is funded through Behavioral Health Funds, available only to individuals with a documented need for residential level of care, as determined by a comprehensive assessment. Continued eligibility requires ongoing compliance with substance use disorder (SUD) treatment, residential level of care requirements, and use of the OneStep app to check in and check out of the house.

Initials Text fieldI have been provided with a copy of, have read, and fully understand the rules, regulations, and expectations of Stronger Sober House LLC.
Initials Text fieldI confirm that I am currently of sound mind and not under the influence of any drugs or alcohol.
Initials Text fieldI acknowledge 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 under local landlord-tenant laws. If local landlord-tenant laws are found to apply, I hereby waive any rights I may have related to such laws.
Initials Text fieldI understand that Stronger Sober House LLC plans and prepares meals to meet the general needs of most residents. Individual dietary restrictions or menu requests may not be accommodated. Menu changes are at the sole discretion of Stronger Sober House LLC. I am responsible for managing my own dietary needs and consume provided meals at my own risk. Stronger Sober House LLC is not liable for any allergic reactions, dietary complications, or health issues related to meals provided. Upon discharge, whether voluntary or due to termination, I agree not to take any food provided by Stronger Sober House LLC.
Initials Text fieldI agree to participate in the mandatory weekly house meeting and to abide by all rules and regulations of Stronger Sober House LLC. I further agree to join the communication tool used by the house, such as OneStep, WhatsApp, or any other designated tool, within 24 hours of admission to facilitate program communication and compliance.
Initials Text fieldI understand and agree that if I violate any rules or regulations of Stronger Sober House LLC, I may be discharged from the program and forfeit any prepaid program fees. I acknowledge that the final determination for any disciplinary action will be made by management and is not subject to appeal.
Initials Text fieldI agree that, whether my departure is voluntary or due to termination, my personal property will be held for up to 60 days. During this period, Stronger Sober House LLC is not liable or responsible for my personal belongings. After 60 days, any remaining personal property may be donated or disposed of.
Initials Text fieldI understand and agree that Stronger Sober House LLC reserves the right to amend, modify, or update its rules, regulations, and expectations at its sole discretion to ensure the safety, well-being, and operational needs of the sober living community. Any changes will be communicated to residents in writing (via posted notice, email, or other reasonable means). Continued residency constitutes acceptance of any such changes.
Initials Text field I hereby release and hold harmless Stronger Sober House LLC from any lawsuits that may be brought by me, my family, or my heirs, in perpetuity, for any tort or action whatsoever.

Sober Living Rules and Regulations
Please read carefully. We have zero tolerance for dishonesty, disrespect, or rule violations.
TREATMENT EXPECTATIONS
You are expected to schedule all medical, dental, and mental health appointments outside of your treatment programming hours.
You are expected to attend ALL scheduled program groups.
You are expected to arrive on time and stay until the group is dismissed.
If you miss treatment for any reason, you must contact three people: Your treatment counselor, house manager and the owner directly at: 651-243-2343 via phone call or text.
If you miss treatment due to court, emergency doctor visits, or other professional appointments, you must provide paperwork to prove your whereabouts.
If you miss treatment due to illness, you must stay in the house for the entire day.
If you miss treatment due to illness, you must attend treatment via Zoom.
If you are NCNS (No Call No Show) to treatment, expect the following:
--1st NCNS: 3 days restriction. Missing treatment means non-compliance with Stronger Sober House LLC’s rules and regulations, resulting in no overnight or visitor privileges.
--2nd NCNS: 1 week restriction and a $50 fine due immediately.
--3rd NCNS: Discharge from housing. You must wait 30 days before re-entry. If interested in re-entry, staff will discuss if you are a good fit for the house. If deemed a good fit, you may return.
If you are discharged from your treatment program, you will be discharged from the house. If you transfer out of your treatment program without discussing with staff first, you will be discharged from the house. There are NO EXCEPTIONS.
MEDICATIONS/MAT
You are responsible for keeping track of your medication. You MUST keep medications secured in a lock box, which you are responsible for providing.
Do not share medications.
Take medications only as prescribed. Stronger Sober House LLC has the right to conduct a medication count under any suspicion of medication abuse. A client who violates this policy will be informed of the violation and instructed to stop the behavior. Failure to comply can and will result in disciplinary action and/or termination from the house.
The following guidelines are in place:
Mood-altering medications (e.g., opiates, benzodiazepines, barbiturates, sedative-hypnotics, diet pills) are strictly prohibited.
In rare instances, a client may require brief use of certain medications for a medical procedure or pain. Residents must submit a document from a physician stating the necessity of the medication, and staff must approve its use. Medications MUST be stored in a locked box.
Clients must inform staff of any prescriptions/medications upon admission and any received while a resident. Failure to do so can and will result in termination.
Clients may take over-the-counter medications.
Clients must be able to self-administer their own medication without the aid of a healthcare professional. If unable to do so, this house is not suitable.
Clients on MAT (medication-assisted treatment), including buprenorphine, MUST keep medications in a lock box. The goal of MAT is to sustain recovery and taper when appropriate. We support all efforts to taper off MAT medication.
Gabapentin is considered a drug of abuse and must be stored in a lock box, following the same guidelines as MAT medication.
Clients are responsible for proper medication dosage. Medications must be stored properly and discreetly, not on countertops or dressers. The preferred storage is a lock box, out of plain sight.
Any deviation from proper medication dosage will be investigated by staff. Deliberate alteration to alter mood can and will result in termination.
Clients must not discontinue prescribed medications without prior authorization from a medical doctor.
SEARCH FOR INAPPROPRIATE/ILLEGAL HAZARDOUS ITEMS
Stronger Sober House LLC seeks to ensure the safety of all clients and provide an environment conducive to recovery from addiction. Staff have the right and responsibility to search clients’ belongings and the entire residence for illegal substances and inappropriate hazardous items at any time without announcement or permission.

RANDOM DRUG SCREENS
Staff reserve the right to administer a urine/saliva drug screen or breathalyzer to a client at any time. The following procedure applies:
Once a drug screening is requested, the client must remain in the presence of staff until able to produce a sample.
Clients have up to 1 hour MAXIMUM to produce a sample; failure to produce will be deemed a positive result, and necessary actions will be taken and involving police if necessary.
Results are documented in the client’s file.
INTERVENTION FOR THE INTOXICATED/IMPAIRED CLIENT
If a client relapses by becoming intoxicated or impaired by any substance, staff will implement the following procedure:
A) Staff observing or informed of possible intoxication should evaluate by assessing:
Is the client’s behavior uncharacteristic of their normal demeanor?
Does the client have slurred speech or an unsteady gait?
Does the client have an odor of alcohol or another substance?
B) If assessed as intoxicated or impaired, staff will ask if the client has been drinking/using a substance. If the client acknowledges use, staff will decide whether the client needs detox.
If the client refuses detox, they will be discharged immediately.
If the client agrees to detox, staff will assist in finding detox availability. If none is available, the client must agree to be seen at a hospital and be medically cleared by a doctor.
Transportation is the client’s responsibility (e.g., Uber, bus, friend, family, walking, PRS). Staff are not responsible for arranging transport.
C) If the client denies use, management should perform a drug screening for evidence. A room search may also be conducted to ensure no illegal or dangerous substances are present.
If the drug screen is positive or the search reveals alcohol or mood-altering/illegal substances, follow procedure “B.”
DISCIPLINARY ACTION
Clients who fail to adhere to the rules agreed upon at admission will be subject to progressive disciplinary procedures and/or discharge. Rule infractions that CAN AND WILL result in immediate discharge:
--Using mood-altering chemicals/alcohol with another client or on the property.
--Possession of drugs, alcohol, or related paraphernalia on the property.
--Lying, dishonesty, or deceit. Honesty and transparency are the best policy.
--Any form of threats or physical assault toward self or others.
--Suicide attempts or verbal intent to harm—staff will call the mobile crisis team.
--Smoking ANYTHING inside the property.
--Theft of any kind.
--Other rule infractions (e.g., violating curfew, not doing chores) will follow a progressive redirective model:
Initial restriction/loss of privileges.
--Behavioral contract to address the behavior.
--Final discharge from the house.
In the event of discharge, consequences are immediate. The client must arrange alternative accommodations and transportation. Only 30 days are allowed to retrieve personal belongings, coordinated with a staff member. If a client arrives without prior arrangements, staff reserve the right to call the police.
SMOKING
Smoking inside the recovery residence is strictly prohibited. It is against fire codes and endangers personal safety. Clients may only smoke outside of the house and must dispose of cigarette butts responsibly in designated butt cans.

No e-cigarettes or vaping allowed inside the house.
Smoking inside the residence is STRICTLY PROHIBITED and will not be tolerated. Staff will discharge you immediately, and you will not be allowed to return to any Stronger Sober House LLC facilities.
If you are authorized to use medical cannabis, you must leave the property to use it. This will be strictly enforced to ensure the safety of all clients in the house, as the smell of cannabis can be triggering to some people. Be considerate, or you will be asked to leave housing.
A resident who violates this policy will receive only one warning. Failure to comply can and will result in immediate discharge from the house.

EMERGENCIES AND WHAT TO DO

Your safety and the safety of others is our top priority. Upon move-in, you are informed of emergency procedures. In any emergency, call 911 first if you witness or experience any of the following: Fire, violence or threats, suspicious individuals, burglary, chest pain, shortness of breath, suspected overdose (after Narcan), suicide attempt, someone unconscious, a serious fall, broken bone or unstoppable bleeding, ingestion of toxic substances, extreme allergic reaction, hallucinations, out-of-control or paranoid behavior, or if you cannot wake someone.

After calling 911, immediately inform staff and move to a safe place to wait for help. Do not move an injured person unless you are trained to do so.

Notify staff right away if you observe:

Drugs, alcohol, or weapons on site
Someone using or suspected of using substances
Power outage over 30 minutes
Plumbing or maintenance issues
Someone in withdrawal and struggling
Curfew violations
Theft or suspected theft

RULES & REGULATIONS

You are encouraged to attend (3) 12-step/support meetings per week (2 if working a job).
You are encouraged to find a sponsor.
You are encouraged to work with Stronger Sober House LLC’s Peer Recovery Specialist Team to receive peer support services.
House meeting attendance is mandatory, held once weekly. You must arrange with your employer to ensure work does not interfere with the house meeting. There are no exceptions to this rule.
Curfew varies by house; confirm with House Manager.
For the first 30 days, no overnights are allowed. After 30 days, maximum of 2 overnights per month. Overnights must be approved by a staff member at least 24 hours in advance and includes where and when you will return. House Manager will make restrictions to overnights on a case-by-case basis as needed.
Your room must be kept neat: bed always made, carpets vacuumed, absolutely no glasses, dishes, or silverware in bedrooms, and trash must be disposed of in a timely manner. No dirty laundry piles—ever! Laundry must be washed, put away in a timely manner, and dirty laundry must be kept in a laundry basket.
Common areas must always be kept clean and free of clutter and personal items. Any personal property left in common areas will be discarded or donated. No sleeping on the living room couch.
Residents must use house utilities and resources responsibly. Leaving windows or exterior doors open while heating or air conditioning is operating, wasting water or electricity, tampering with thermostats or other house systems, or otherwise misusing house resources is prohibited and may result in disciplinary action, fees for damages, or discharge.
Each client will be assigned a chore, mandatory for your stay, and to be completed as necessary, usually daily or 2-3 times a week, which will be changed weekly at the house meeting. Clients must perform a “deep clean” of their assigned chore at the end of each week before the mandatory house meeting.
Auto repair is strictly prohibited on the property.
Bikes and other modes of transportation are strictly prohibited inside the house (NO EXCEPTIONS) and must be kept outside. Security for these is at your own risk.
Any situation or incident involving police must be reported to a staff member immediately.
Visitors are allowed ONLY in common areas, never in bedrooms (NO EXCEPTIONS). All visitors must be sober. Staff reserve the right to request a visitor submit to drug testing if suspected of being under the influence and may ask visitors to leave if they are disrespectful, obviously under the influence, or acting suspiciously.
You are required to attend to your daily hygiene needs and wash your bedding once a week.
No one is allowed in another resident’s room under any circumstances. There are NO exceptions.
There is NO sharing of clothes, personal property, loaning money, or borrowing vehicles, as these often lead to unhealthy relationships between residents.
Any client aware of another client disobeying these rules who fails to notify staff immediately will also be subject to discharge. We are NOT the police—therefore, it is NOT “snitching.” Holding peers accountable is best for your and everyone’s recovery.
Bring only 2–3 bags of essential personal items that fit in your dresser, closet, or under the bed. Excess belongings will be reviewed by the House Manager or Owner and must be removed. Storing items in other areas of the home is strictly prohibited.
Any delegation, directive, or request made by Stronger Sober House LLC’s staff is expected to be followed.
Any prescriptions or over-the-counter medications with unreadable or missing labels will be disposed of.
ABSOLUTELY NO eating in bedrooms; food must always be kept in food storage/kitchen and labeled and properly disposed of. House dishes are not allowed in bedrooms. If you need a beverage at night, you must supply your own water bottle/cup.
Theft, criminal behavior, unusual behavior, disruptive behavior, or dishonesty CAN & WILL result in immediate discharge.
Failure to submit/produce for a drug screening CAN & WILL result in immediate discharge.

DECLARATION I have read and understand the rules and regulations of Stronger Sober House LLC, and I agree to follow them for the duration of my residency. I understand that failure to comply with these rules and regulations can and will result in immediate discharge from the program.

Signature: Signature

Date: Date

Print Name: Text field

Resident Forms

There are five forms to initial: 1. Client Rights, 2. Release of Information, 3A. Release of Common Entry OR 3B. Documentation of Refusal, 4. Policy of Fraternization 5. Acknowledgement of PAPP, Grievance Procedures, TB/HIV Information, and Reporting Procedures.

Please initial each one, then sign once at the end to acknowledge all of them together.

1. Client Rights
I acknowledge that I have been informed of my rights as a resident of Stronger Sober House. I understand that I have the right to:

Be treated with dignity, respect, and fairness, regardless of race, religion, gender, disability, or health status.
Receive services free from abuse, neglect, or financial exploitation.
Privacy and confidentiality of my personal and medical information, in accordance with HIPAA and Minnesota state laws.
Access to appropriate medical, behavioral, and social services as outlined in my care plan.
File a grievance without fear of retaliation, following the facility’s grievance procedures.
Participate in the development of my care plan and receive regular updates on my progress.
Refuse services or treatment, to the extent permitted by law, and be informed of the consequences.
Access my records upon request, subject to legal and procedural guidelines.
A safe, clean, and supportive living environment.
Be informed of all facility rules, policies, and procedures, including those related to Program Abuse Prevention, TB/HIV, and reporting maltreatment.

Initials Text field I have received a copy of these rights and have had the opportunity to ask questions. I understand my responsibilities as a resident and agree to comply with facility rules.

2. Authorization to Release Information
Initials Text fieldI authorize Stronger Sober House to share and receive information with the following outpatient treatment provider to coordinate my substance use disorder (SUD) treatment and verify my eligibility for residential level of care:

Information to be Shared: Attendance records for SUD treatment sessions, Progress reports related to my treatment plan, Verification of residential level of care eligibility.

Purpose of Disclosure: To coordinate care, ensure compliance with treatment requirements, and verify eligibility for residential services under Minnesota DHS standards.

Duration of Authorization: This authorization remains in effect for the duration of my residency at Stronger Sober House, including any necessary period before and after my stay, typically not exceeding one year from the date of signing, unless revoked earlier in writing.

Revocation: I understand I may revoke this authorization at any time by submitting a written request to Stronger Sober House, except to the extent that action has already been taken based on this authorization.

Confidentiality: All information shared will be handled in accordance with HIPAA and Minnesota state confidentiality laws.

Treatment Provider NameText field

3A or 3B
I intend to Consent to report to the Minnesota Adult Abuse Reporting Center (MAARC) OR Documentation of Refusal to Authorize MAARC Reporting:

Radio buttons

3A. Release for Common Entry Point
Authorization to Report to MAARC:
Initials Text field I authorize Stronger Sober House to report any suspected maltreatment, abuse, or neglect to the Minnesota Adult Abuse Reporting Center (MAARC) as required by Minnesota Statutes, sections 626.557 and 626.5572.

MAARC Contact Information: Phone: 1-844-880-1574 Online Reporting: www.mn.gov/dhs/reportadultabuse Hours: 24/7

Purpose of Reporting: To ensure my safety and comply with state-mandated reporting requirements for vulnerable adults.

Revocation: I understand I may revoke this authorization at any time by submitting a written request to Stronger Sober House, except to the extent that action has already been taken.

3B. Documentation of Refusal to Authorize MAARC Reporting

Initials Text fieldStatement of Refusal: I have been informed of the purpose of reporting suspected maltreatment to the Minnesota Adult Abuse Reporting Center (MAARC). I choose not to authorize Stronger Sober House to report on my behalf, understanding that staff are still mandated reporters under Minnesota law and may report suspected maltreatment without my consent if required.

MAARC Contact Phone: 1-844-880-1574 Online Reporting: www.mn.gov/dhs/reportadultabuse Hours: 24/7

4. Policy on Fraternization
To maintain a professional and therapeutic environment, Stronger Sober House prohibits inappropriate relationships or interactions between clients and staff, or between clients, that could compromise the integrity of the program.

Definition of Fraternization: Fraternization includes romantic, sexual, or overly personal relationships between clients and staff, or between clients, that disrupt the therapeutic environment or violate professional boundaries.
Prohibited Actions:
--Engaging in romantic or sexual relationships with staff or other clients.
--Exchanging personal gifts, money, or favors with staff or other clients.
--Engaging in private communications (e.g., personal phone calls, texts, or social media) with staff outside of professional duties.
Consequences: Violations of the fraternization policy may result in disciplinary action, including warnings, care plan reviews, or discharge from the facility, depending on the severity. Staff violations may lead to termination.
Reporting: Clients are encouraged to report suspected fraternization to the House Manager or through the grievance procedure without fear of retaliation.

Initials Text fieldI have read and understand the above client expectations, rules, and fraternization policy. I agree to comply with these rules during my residency at Stronger Sober House. I acknowledge that any violation of these rules may result in disciplinary action, up to and including immediate dismissal as a resident and requirement to move out immediately, with serious violations such as substance use or violence resulting in immediate dismissal. I further acknowledge that funding for my housing is provided through Behavioral Health Funds, which requires a documented need for residential level of care, and I must comply with SUD treatment and assessment requirements to maintain eligibility.

5. Acknowledgement of PAPP, Grievance Procedures, TB/HIV Information, and Reporting Procedures

Initials Text fieldI acknowledge that I have received, under the Resources Section under the OneStep App, and reviewed the following documents and information from Stronger Sober House:

Program Abuse Prevention Plan (PAPP): I understand the facility’s plan to prevent abuse, neglect, and exploitation, including policies on fraternization.
Grievance Procedures: I have been informed of how to file a grievance if I have concerns about my treatment or the facility, without fear of retaliation.
TB/HIV Information: I have received education on tuberculosis (TB) and HIV, including prevention, transmission, and care protocols.
Internal and External Reporting Procedures: I understand how to report suspected maltreatment internally to staff and externally to the Minnesota Adult Abuse Reporting Center (MAARC) at 1-844-880-1574 or www.mn.gov/dhs/reportadultabuse.

Initials Text fieldI have had the opportunity to ask questions about these documents and procedures, and I understand my rights and responsibilities.

Print Name: Text field
DOB: Client birthdate

Signed: Signature

Date Signed: Date

Admission Date: Date