Cupid Homes Rules & Online Application

Cupid Homes Rules & Online Application
All terms of this agreement are in effect for the next 30 days.
1. Rent is due on Friday by 6 pm. If rent is not current after 30 days you will continue 30-day restrictions.
2. Curfew is 8 pm on weekdays and 8 pm on weekends.
3. No overnight passes for 30 days.
4. Sign-in & Sign-out sheet for 90 days.
5. Kindness, tolerance and understanding will be expected by all House tenants at all times. Any conflicts should be resolved immediately, first with the individual tenant, and with the assistance of staff, if needed.
6. Name calling, back-stabbing, gossiping, negativity about or toward another will not be allowed. This will include blaming others, bad-mouthing others, criticizing, judging, and causing others to take the blame for something they did not directly do.
7. Support, help, and encouragement will be given to each tenant by all other tenants at all times.
8. If any tenant has reason to believe that another tenant is using, this must be brought to the attention of staff immediately. Someone’s life may depend on this.
9. Those without a job and not current on rent will be out looking for work by 8:00am until 3pm every day except Sunday.
10. Every tenant will attend 3 (three) meetings per week minimum.
11. Every tenant is required to go to church weekly.
12. Tenants will contact their Sponsor every day.
13. Smoking Cigarettes and Vape is Never permitted inside the house.
14. Taking another’s food is stealing. Food is an individual responsibility.
15. House cleaning is to be done weekly by all members. We do implement a chore list that will be checked daily. Dishwashing is an individual responsibility, and should be cleaned immediately after use.
Name

First NameLast Name
Do you have bedding?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Are you employed?
If yes, name of company?
How many hours a week do you work?
Work Number
Please enter a valid phone number.Format: (000) 000-0000.
College student?
College (if applicable)
Receiving SSI or Disability Payments?
If yes, what type of payments?
Means of transportation (if any)
Marital Status
Do you have any sexual or violent charges?
Type(s) of charges
Felony Convictions? (what, where, when)
Are you or have you ever been registered as a sex offender?
PO's name and number
Court Case/Charges Pending
If Yes, what type, location and time frame?
Example: Sober Living, Second Chance, March 2017-October 2017
Do you have medical problems (physical, emotional or allergies)?
If so, please list. If not please write "none"
Do you have medical problems (physical, emotional or allergies)? *
If so, please list. If not please write "none"
Are you diabetic?
Medications?
Age you first used/drank?
Drug of choice?
Date of last use?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Treatment Program Completed?
Completion Date?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Emergency Contact (1) Name / Relationship *
Emergency Contact (1) Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (2) Name / Relationship
Emergency Contact (2) Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (3) Name / Relationship
Emergency Contact (3) Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Rules
- I will not have possession of weapons on my person or in my living quarters (Knives, Guns, throwing stars, etc…)
- I will forfeit my deposit if I have a slip or relapse.
- I will not use drugs or alcohol any time, any place, for any reason.
- Between 30 and 90 I will have a curfew of 8pm Sunday thru Saturday. (Rent Current)
- After 90 days I will have a curfew of 12 Midnight Sunday thru Saturday. (Rent Current)
- I will attend 12 step meetings regularly and have my meeting sheet signed for the first 90 days. (If you do not have a job attend one meeting a day)
- I will clean-up after myself as I go. (No one wants to live with a slob!!)
- I will not move furniture or make any changes to the house without permission.
- Do not bring your own TV. We will provide one.
- I will not cause any altercations. (No physical Fighting!)
- I will not bring visitors in the house. (No spouses, girlfriends, or boyfriends!)
- I will not cause any problems with my roommates or staff.
- I will keep a job or be actively seeking employment.
- I will have my Rent paid every Friday by 8PM for the coming week.
- I will attend the Mandatory House Meeting at 7:30 P.M. a Men’s House Meeting Tuesday at 6:00 P.M., during the first 90 days (If I’m scheduled to work I will notify management by text message.)
- No Phone Calls to management on Saturday & Sunday!
Check the box below if you agree to these rules
Signature
Should be Empty: