Welcome Packet Forms

Fee Schedule Agreement

I, Client first name Client last name understand and acknowledge that I am entering into a recovery program. My enrollment in this program is voluntary.

Please check the option that applies below:

Checkboxes

DUE ON FIRST DAY OF STARTING PROGRAM:

Initial starting program fee = $265.00 (includes 1st Week) + prorated amount for starting in the middle of the week.

WEEKLY FEE = $165.00 Fee Paid on Sunday

If your balance is not at zero, restrictions will apply. (NO OVERNIGHT PASSES, DAILY CURFEW, AND OTHER PRIVILEGES AT DISCRETION OF STAFF; INCLUDING GETTING RELEASED FROM THE PROGRAM)

If you are past due; 75% of all compensation to you (from any source), goes towards paying said fees.

Program fees are a priority, you should be able to budget and plan for other expenses, such as food, fines, court costs etc. Most courts and P.O’s will work with you as they understand that housing is a basic primary need. If you are having any issues please get with your house manager and/or program coordinator to resolve any conflicts before spending any income.

Signature: Signature

Manager: Oren Golanski Date: Date

Contract

New Beginnings Sanctuary NC Program Agreement

Welcome to New Beginnings Sanctuary NC (NBSNC). We are committed to your recovery and are glad you're here. These guidelines outline the agreements that ensure your success and the safety of our community. By signing, you agree to follow these guidelines.

Behavior That Will Result in Me Choosing to Leave NBSNC

NBSNC provides a living environment conducive to healing and recovery. As a participant, you agree to:

Zero Tolerance for Alcohol and Drugs: You will not possess or use alcohol or drugs on or off the NBSNC property. This includes any substances that alter the mind or mood (e.g., Kratom, CBD, synthetic drugs). Violations will result in me choosing to leave the program.
Respectful Behavior: Threatening, abusive, discriminatory, or assaultive behavior is not acceptable. Physical violence, theft (including food), destruction of property, and all listed behavior will result in me choosing to leave the program.
Weapons: Weapons, including knives and firearms, are prohibited. Violations will result in me choosing to leave the program.
Sexual Misconduct: You agree to not engage in sexual misconduct or harassment. Any relationship between residents and staff is strictly prohibited, and violations will result in me choosing to leave the program.
Criminal Activity: Engaging in criminal behavior on or off NBSNC property will result in me choosing to leave the program and may be reported to authorities.
Financial Misconduct: Financial exploitation or dealings between residents are prohibited. Borrowing or loaning money, bartering, exchanging, or selling personal property, or the solicitation thereof is prohibited within NBSNC. Such practices can and frequently do lead to misunderstandings and conflict between individuals and program members in general and will result in me choosing to leave the program.
Substance Abuse Reporting: If you are aware of substance use or other violations by another resident, you have an organic responsibility for keeping the house safe from others who wish to openly disregard those in the house and report it to NBSNC staff.
Smoking and Vaping: Smoking or vaping is prohibited inside the building.
Chores and Cleanliness: You must complete your assigned chores and maintain cleanliness in your room and common areas.
Recovery Meetings: You are agree to attend at least 4 recovery-based meetings per week.
Curfew Compliance: You must comply with the curfew rules set forth by NBSNC.

Zero Tolerance Policies

Substance Abuse: NBSNC has a strict zero-tolerance policy for all forms of alcohol, drugs, and related paraphernalia. A violation of this policy will result in my choosing to leave the program.
Violence and Theft: NBSNC maintains a zero-tolerance policy for any form of violence, threats, intimidation, discrimination or theft. Any such behavior will result in me choosing to leave the program and may be reported to authorities.

Program Participation

Voluntary Participation: Your participation in the program is voluntary. By paying the program fee, you are a participant, not a tenant, and these fees are not rent.
Program Fees: Fees are due weekly on Sundays. Failure to pay on time may result in me leaving the program. If you cannot pay your dues, you must notify your program director and executive director about your payment plan. It is up to the director's discretion to agree to your payment plan. Communication is a key component of your payment plan. Please communicate early and often.
Program Fees are: $165 per week, Paid every Sunday. Entry Fee $265 (includes the first week).
Vacating the Property: If I am asked to leave the program, I must vacate the property within one hour with all belongings. Any belongings left behind will become the property of NBSNC.

Chain of Command for Issues or Complaints

House Manager
Housing Director
Executive Director (for grievances against the Housing Director)

Accountability and Technology Use

One Step Software: You must download and use the One Step app to check into recovery meetings, Intensive Outpatient Program (IOP) sessions, and employment (only if your work keeps you past curfew and at the request of the house manager or directors).

Curfews and Lights Out and Nightly Check-in

Curfew

Sunday to Thursday: Curfew is 11:00 PM.
Friday to Saturday: Curfew is 12:00 AM.

If attending a meeting or employment outside of curfew, you must seek approval from NBSNC staff. You may also be asked to check in and out via the One Step app.

Lights Out
Lights out is one hour after curfew:

Sunday to Thursday: 12:00 AM.
Friday and Saturday: 1:00 AM.

Lights out means all common areas of the house should be quiet and shut down. If you use an electronic device, you must wear earphones or headphones and be mindful of your roommate and housemates. During lights out, please refrain from doing chores, starting laundry, hanging out in common areas, going in and out of the house to smoke, opening or closing the garage, etc. We expect everyone to show courtesy and respect to their housemates, just as you would expect in return.

Late Arrival
I understand that if I arrive late, I may be subject to an immediate drug screening (UA) at my own expense of $10.

Check-in Policy
I agree to inform my house manager via GroupMe when I am home for the night. This policy ensures that everyone is accounted for and safe.

Overnight Passes

On your 31st day, you may request and receive 2 overnight passes per week.
Requests for overnight passes must be submitted at least 24 hours in advance for approval. To request an overnight pass you must create a group text with your house manager and program director.
To receive overnights, you must be current on your dues, attend all your meetings, do your chores, and keep a clean personal space. Your behavior in the house is also considered when making approvals.

Sexual Misconduct and Relationships Sponsors

Sexual Misconduct: Sexual misconduct, including inappropriate touching, kissing, or sexual involvement, is prohibited.
Relationships: NBSNC advises and encourages residents to avoid relationships during their early recovery journey. Again this is simply encouraged. Most people will tell you the fastest way to go “back out” is to be in a relationship too soon. Swipe left!

Drug Testing and 72 Hour Dismissals

Random Drug Testing: This recovery housing program requires random drug screenings as part of the residency. I agree to participate in these screenings, which may occur without prior notice, cause, or explanation. If I fail to test or do not complete a test within one hour of the request, it will be treated as a positive result, and I will be asked to leave the program.
If I fail a drug test or am found intoxicated, I may be offered detox or a 72-hour dismissal, but this is not guaranteed. A 72-hour dismissal will only be considered if I am honest about my substance use and take responsibility. The decision to offer detox or a 72 Hour dismissal is at the sole discretion of management, taking the severity of the infraction into account. If granted a 72-hour dismissal, I must return on the agreed date and time, pass a drug screen, and have all fees and fines up to date in order to re-enter the program.
In the case of immediate discharge, I will have 45 minutes to remove my belongings. Any unclaimed items left behind for more than three days will become the property of NBSNC.
Testing for THC upon Entry to the Program: If I test positive for THC upon entry, I understand that I must pay for an independent lab test, which costs $50. This test will report my THC levels. Thirty days after entry, I will be tested again. If that test is also positive, I will be responsible for another lab test at a cost of $50. The results of that test must show a significant decrease in my THC level, or it must be gone entirely. If the results do not show sufficient progress, I will be asked to leave the program.

Tobacco Use

Designated Smoking Areas: Tobacco products may only be used in designated outdoor areas. Smoking or vaping indoors will result in me choosing to leave the program.

Medications

Disclosure and Storage: You must disclose all prescription medications upon entry to NBSNC and/or if you receive new medications during your stay. Narcotics and controlled medications will be stored by NBSNC staff and dispensed weekly. Any medications that do not need to be stored by NBSNC must be kept safe and out of sight of other residents.
NBSNC is MAT (Medically Assisted Treatment) Friendly. I understand that Suboxone treatment is a privilege and that there are specific protocols to follow if I am prescribed Suboxone. NBSNC allows participants to be prescribed Suboxone, but the following guidelines must be adhered to:
You may take a maximum of 8mg per day.
Suboxone will be held by the house manager and distributed weekly during house meetings.
Your weekly supply must be stored securely and kept out of sight of other participants.
NBSNC reserves the right to conduct counts at any time. If the count does not match, I understand that this will be considered a violation and will result in my choosing to leave NBSNC due to the misuse of narcotics.
If you have not beenprescribed Suboxone prior to your entry to the Program you can not simply decide to request a prescription and begin taking it. Please ask your director for more information if this is something that comes up.

Weekly House Meetings

Mandatory Attendance: Weekly house meetings are required. This is when the entire house gets together and discusses topics pertaining to the house and a check in with all participants. House meetings play a vital role in ensuring the house runs smoothly and efficiently. Failure to attend your house meetings will result in my choosing to leave the program.

Recovery Meetings, Classes, In-house 12 Step Meetings and Sponsors

Mandatory Recovery Meetings: You must attend at least 4 recovery meetings per week. These meetings should be approved and not include meetings with your sponsor, individual therapy, or online meetings.
Approved meetings include: IOP, AA, NA, CA, Religious Service, Religious study, Celebrate Recovery, etc. I understand this does not include meeting with my sponsor, individual therapy, or online meetings. I understand that failure to make 4 meetings within a week will result in me making up the meetings missed the following week. (Example: if you miss one meeting the following week you will need to do 5 meetings) I further understand that if I do not make my mandatory meetings, I am choosing to leave NBSNC.
You are required to check into these meetings using the One Step app.
Each House is permitted to conduct its own AA/NA meeting inside the house with their housemates. This meeting WILL count towards your weekly meeting count. In order to do so the following must occur:
- Run a real 12-Step meeting
- Starting with the serenity prayer, readings, chips, etc
- Be a minimum of 1 hour long
- There must be at least 4 housemates present for the entire hour.
- Someone must volunteer to chair the meeting
- Check-in using Onestep
Sponsor: I agree to have a sponsor in the first 21 days of entering

Resident Rooms

Visitor Restrictions: Visitors are not allowed in your room for any reason. Guests must be sober, and you need to inform the house manager/Director and housemates via group chat about any visitors.
I understand that guests/visitors should be off the property ONE HOUR prior to curfew. 10pm Sunday - Thursday and 11pm Friday - Saturday.
I commit to being mindful and respectful of my guests' length of stay. I understand this is a shared home and will keep visits to a maximum of 2 hours.

Overall Cleanliness

You are responsible for keeping your space neat, making your bed daily, and keeping your personal belongings tidy.
All assigned chores must be completed on the day assigned.
I understand that personal hygiene is important and I agree to shower daily and wash my clothes and bed linens weekly.

Employment Daily Routine

Job Search: If unemployed, you must search for work daily and submit at least 5 in-person applications per day OR 20 online applications. Both require proof. Screenshots of your online applications should be texted to your house manager and program director. Photos of your in-person applications will suffice.
I understand and agree to be out of bed by 8:30 am and remain so until 4:00 pm unless authorized by an NBSNC staff member. This rule is critical for those who are unemployed and need to be looking for work.
I understand if I have outside employment, I am exempt from this rule.

Cameras

Cameras are present in common areas. Tampering with cameras will result in me choosing to leave the program.

Behavioral Reviews

Non-Compliance: If you fail to comply with rules outside of the zero-tolerance policies, you will be given a chance to improve. If you become a habitual offender, you are choosing to leave the program.

Refund Policy

A 1-week notice is required if you plan to leave the program. Failure to provide notice will result in forfeiture of any pre-paid program fees.

Parking Policy

Parking is subject to the house's parking policy. You must follow basic parking rules, such as not blocking driveways or parking in fire zones.

House Mindfulness and House Bills

I agree to be mindful of utility usage and help NBSNC keep their weekly program fees as cheap as possible by:
- turning off the lights when I leave any room even if you didn't turn it on and you “thought someone was coming back.”
- Being mindful of water use. Turning off the water when brushing your teeth and keeping showers to reasonable time frames
- When using the washer and dryer do not just wash one item. Wash all your clothes and linens weekly together if possible in an effort to conserve water.
As inflation in rents, home goods, and energy costs continue to rise we are doing our best to keep your program fees as low as possible. In return please help us keep our energy consumption down so we can keep program fees at their current rate.

Fines

We do not have a fine system. If you cannot live by these rules, you are choosing not to be part of our program.

I agree and understand that continued disregard for any of these rules will result in my choosing to leave NBSNC.

23. Additional Privileges with Sober Time

After six months of sobriety in NBSNC, weekly meeting requirements drop to 3 times per week.

I Client first nameClient last name agree and understand that continued disregard for any of these rules will result in my choosing to leave NBSNC.

Signature Resident signature

Signature Staff Signature

Move-in date Date Resident Initial Initials Text field

Head Director (print): Oren Golanski

Director Signature:

Date: Date

Josh Bone 704.912.8072

Oren Golanski 704.706.3236 J

ennifer Arena 919.360.1611

Nicole Young 720.625.2747

Jonathan McCullen 980.310.4715

David Lancaster 704.241.4977

Background Check Authorization Form

To whom it may concern:

I Client first name Client last name give consent and permission to New Beginning Sanctuary NC to compile and request a complete criminal background/history. This criminal background check shall remain in my file.

Client Signature:
Signed: Signature

Date: Date

Liability Waiver Advertising/Photo Release Form

NBSNCwill occasionally take photos of residents during activities and/or classes or at other times for the purpose of use in our website, brochure, or other advertising materials. We respect your privacy and would never use your image in our advertisements unless you specifically allow us to do so.

In consideration of my engagement as a model, upon the terms here with stated, I hereby give to New Beginning Sanctuary NC legal representatives and assignees, those for whom NBSNC, and those acting with NBSN Cauthority and permission:

a) The unrestricted right to copyright and use, re-use, publish, and re-publish photographic portraits or pictures of me or in which I may be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations in conjunction my own or factious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever.
b) I also permit use of any printed material in connection therewith.
c) I hereby relinquish any right I have to examine or approve the completed product or products or the advertising copy or printed matter that may be used in conjunction therewith or the use to which it may be applied.
d) I hereby release, discharge and agree to hold harmless New Beginning Sanctuary NC, their legal representatives or assignees, and all persons functioning under NBSNC permission or authority, or those for NBSNC is functioning, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.
e) I hereby affirm that I am over the age of 18 and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assignees.

Name: Client first name Client last name

Signature:

Signature

Date:Date

WAIVER OF LIABILITY

WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

1. In consideration for receiving permission to participate in the New Beginning Sanctuary NC, I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE New Beginning Sanctuary NC, their officers, agents, or employees(hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in such activity, while in, on or upon the premises where the activities are being conducted, REGARDLESS OF WHETHER SUCH LOSS IS CAUSED BY THE NEGLIGENCE OF THE RELEASEES, or otherwise and regardless of whether such liability arises in tort, contract, strict liability, or otherwise, to the fullestextent allowed by law

2. I am fully aware of the risks and hazards connected with the activities of New Beginning Sanctuary NC, and I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of being in the New Beginning Sanctuary NC Sober living program, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise, to the fullest extent allowed by law

3. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage, or costs, including court costs and attorneys fees that Releases may incur due to my participation in New Beginning Sanctuary NC, WHETHER CAUSED BY NEGLIGENCE OF RELEASEES or otherwise, to the fullest extent allowed by law.

4. It is my express intent that this Waiver and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE the above-named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of North Carolina and that any mediation, suit, or other proceeding must be filed or entered into only in North Carolina and the federal or state courts of North Carolina. Any portion of this document deemed unlawful or unenforceable is severable and shall be stricken without any effect on the enforceability of the remaining provisions.

IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Wavier of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age or guardian of minor child and fully competent; and I execute this Agreement for full, adequate and complete consideration fully intending to be bound by same.

PARTICIPANT: Client first name Client last name

Participant signature:

Signature

Date: Date

Head Director: Text field

Date:Date

Proof of Residency

DATE:Date

To whom it may concern;

This letter is to certify, Text field has been a resident with New Beginning Sanctuary NC Sober Living since Date He/She currently resides at: Text field

This letter is to certify that, Text field pays $660 monthly in program fees, including utilities for his/her home at New Beginning Sanctuary NC Sober Homes. Food is not provided. Please contact me directly with any questions or concerns regarding these fees.

Paragraph

Sincerely,

Text field

New Beginning Sanctuary NC Medication Policy

New Beginning Sanctuary NC Sober Homes does not allow any narcotic medications except Suboxone. Participants are allowed to maintain possessin of a 7 supply of suboxone. Any remaining medication will be counted and locked up in the house safe. Participants will be given access to their medication for their weekly supply and once again counted to maintain a proper pill count.

o New Beginning Sanctuary NC does not administer medications.

o Clients will sign for their medication when they accept possession for self-dispensing.

o All other non-narcotic prescriptions are allowed only if they are prescribed to you by a doctor and are taken as prescribed.

o Medications are not shared with any other resident. Residents are responsible for taking care of their own prescription medications.

o You may not consume anything nor bring on property anything that contains alcohol, including but not limited, to over the counter medications or mouth wash.

o All medications must be disclosed, and at any time staff deems necessary, medications may be counted to confirm accuracy of dosages taken.

o Any changes in dosage must be confirmed in writing or by telephone to staff from the issuing doctor. This includes discontinuing of prescribed medications.

o Do not leave medications out where they are in the open or unprotected. Keep in a dresser drawer or with you at all time.

o You are responsible for the control or your non-narcotic medications and any deviations are considered abuse.

o Abuse of any medications will be considered a relapse and may lead to termination from the program.

o Any medication not used, will be turned in to the house manager to be locked up and turned over to the Director for disposal.

Client: Client first name Client last name

Date:Date

Client Signature:

Signature

Director: