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  • Application for Sober Living Homes Membership

    **PLEASE NOTE YOU MUST HAVE MINIMUM 90 DAYS RECOVERY**

  • Date of Birth*
     - -
  • Are you currently homeless or without a permanent residence?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Emergency Contacts:

  • Are you currently in a program?
  • Sobriety date?*
     / /
  • Can anyone provide documentation of your abstinence?*
  • Do you attend AA, NA, or other self help meetings?*
  • Do you currently have a home group?*
  • Do you currently have a sponsor?*
  • Are you currently prescribed any medications?*
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  • Any medical issues and/or physical limitations?*
  • History of treatment for mental health and/or self-harm in the past 2 years?*
  • Are you currently on probation?*
  • Are you currently on parole?*
  • Will we need to be in contact?*
  • Format: (000) 000-0000.
  • Any drug court involvement?*
  • Do you have any outstanding warrants/open cases?*
  • Have you ever been arrested or convicted for any violent, sexual, and/or arson-related crimes?*
  • Are you currently employed?*
  • Enrolled in school?*
  • Engaged in volunteering?*
  • Do you have any other income?*
  • Relationship status (circle one):*
  • Do you have children?*
  • Is there any DCF involvement?*
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  • Do you plan on having a vehicle on the property?*
  • Do you have a valid license?*
  • Do you have valid registration?*
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  • I understand that I am subject to immediate expulsion from the house if any of the following occur:

    1) I use alcohol and/or drugs; other than my prescribed medication(s)

    2) I fail to pay my weekly share of house expenses

    3) I engage in disruptive/aggressive behavior

    4) I participate in any illegal activity on or off the property

    I understand that if I am expelled from the house for any of the above reasons there will be no refunds.

    I agree to abide by the Erin's House principles and fully subject myself to the rules of this house, including but not limited to, mandatory random drug testing, participation in supportive case management services, and weekly community house meetings.

    By signing below, I certify that the information contained in this application is true to the best of my knowledge, that I understand and accept the conditions set forth above for membership in Erin's House, and that I agree to abide by said conditions should I be accepted as a member of this house.

  • Date
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