I First Name Last Name attest that the information above is true and that all medications are prescribed for the labeled purposes and are currently the only medications I am using.
I First Name Last Name agree to the payment of $300 for intake for classes and counseling.I First Name Last Name agree to the payment of $125 a week for rent upon getting a job.I First Name Last Name agree that all information is true and complete on this form.
Makeup Bag- 1
Twin Sheets- 1 set
Laundry Detergent- 1
Shaving Cream, Etc.
ABSOLUTELY NOTHING WITH ALCOHOL (EX. MOUTHWASH OR HAND SANITIZER)
TOBACCO PRODUCTS ARE ALLOWED.
SNACKS AND DRINKS ARE ALLOWED.
DO NOT BRING NARCOTICS, COMPUTERS, TABLETS, SECULAR BOOKS OR MUSIC, OR ENERGY SUPPLIMENTS.