Name - Client first name Client last name
Today's Date: Date
Overnight stays need to be approved by the House Leader/Asst Leader at least 24 hours in advance. You must be in compliance with all the house rules before approved and you must have been in the home for at least a minimum of 14 days. My initials here confirm that I've gotten approval for this overnight. Initials Text field
If you are self-pay or scholarship from a private IOP, no extra fees are due.
If you are MediCal funded IOP, you will need to pay Empowering Potential Housing $30 per night for your missing nights. We prefer Zelle or Venmo, please call Rachel at 619-500-3987 to make arrangements for payment.
Missing Night(s):
Date