Austin Turning Point Resident Questionnaire and Agreement 2024

Legal Name*

First NameLast Name

Phone Number*

Email Address*

example@example.com

Date of Birth*

Date

What city were you born in?*

Potential Move-In Date

Date

Social Security Number (SSN)*

Race*

Ethic Background*

Hispanic or LatinoNot Hispanic or LatinoUnknown

Marital Status*

Gender*

Pronouns

Are you a veteran?*

Are you an Austin/Travis County resident? *

Do you plan on staying in Travis County after your stay at Austin Turning Point? *

Do you commit to staying at Austin Turning Point for 90 days?*

YesNo

Housing Status*

Last Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you planning to come in with child/children? (Women's Homes)

If yes, children's/child's name and ageblanks

Have You Been to Treatment, A Psychiatric Hospital, or a Detox Within the Last Year?*

YesNo

Where did you go to Treatment/ Detox/ Hospital?

What Day Did You Enter Treatment / Hospital / Detox?*

Date

What Day Did You Leave Treatment / Hospital / Detox?*

Date

What Is Your Primary (#1) Drug of Choice?*

When you use {what Is}, how much do you use in a day?
* *

How Often Do You Use {whatIs}?*

Over your entire life, how long have you been using {whatIs}?
* *

What Day Did You Last Use {whatIs}?*

Date

Do You Use Any Other Drugs in Addition to the One Above?*

YesNo

What Is Your Secondary (#2) Drug of Choice?*

When you use, how much do you use in a day?
* *

How Often Do You Use?*

Over your entire life, how long have you been using?
* *

What Day Did You Last Use?*

Date

Are you currently using tobacco products? (including but not limited to cigarettes/vapes)*

Do you have any psychiatric diagnoses such as PTSD, depression, anxiety, bipolar disorder, or schizophrenia? Please list them here: (this field is required if you are applying for assistance)

Prescription Drug List - Please list all medications.

Do You Have a Case Manager at Integral Care, CPS, DACC, CommUnity Care, PES, other Agency?*

YesNo

What is the Name of Your Case Manager?*

What is Your Case Manager's Phone Number?

Which Organization Is Your Case Manager From?*

Do you currently have private insurance? *

Do you have Medicare/Medicaid?*

yesno

What is your employment status? *

What is your monthly income?*

Do you have proof of income? *

Over the past 30 days, how many days have you experienced medical problems? (sickness or physical health problems not related to substance abuse)*

Over the past 30 days, how many days have you experienced education/employment problems? (poor attendance, performance and missed responsibilities)*

Over the past 30 days, how many days have you experienced substance abuse problems? (memory lapses, withdrawal symptoms, cravings)*

Over the past 30 days, how many days have you experienced family problems? (missed responsibilities, verbal or physical abuse, not caring for children)*

Over the past 30 days, how many days have you experienced social problems? (missed responsibilities, verbal/physcial abuse, serious conflict due to poor communication)*

Over the past 30 days, how many days have you experienced psychiatric problems? (serious depression, anxiety, suicidal thoughts)*

Have you ever been convicted of a felony?*

yesno

Do you have any pending court cases?*

yesno

Are you currently on probation or parole?*

yesno

Have you ever been convicted of a sex offense?*

yesno

PLEASE READ CAREFULLY

Austin Turning Point Resident Agreement

Rev. 11/2024
Services

Austin Turning Point is committed to ensuring a structured, safe, clean and spiritual living environment in which women and men in recovery from substance use disorders can thrive. Our vision is that women and men in recovery from substance use can achieve and maintain emotional, mental and physical sobriety while enriching their lives through personal and group accountability, character and self-esteem building, and establishment of a routine that fosters a new, sober lifestyle. In the spirit of our vision, we aim to guide residents toward their goals through accountability and peer support.

Financial Responsibility

To secure residency at ATP, we kindly request the following payments:

- A monthly membership (rent) payment of $850.00, along with a non-refundable $250.00 move in fee is required.
- Rent is due on the day of admission and subsequently every 30 days.
- Please ensure that rent payments are made promptly, as any delay beyond the due date will incur a late fee charge of $10.00 per day.
- For your convenience, we accept payments through various methods, including check, money order, and credit/debit card. We gladly accept VISA, MasterCard, Discover, and American Express, as well as online platforms such as Venmo, PayPal, Cash App, and Zelle. However, please note that we do not accept cash payments.

Additionally, we offer single rooms specifically designed for women, which include a children's program at a rate of $60 per day. The maximum stay allowed in these rooms is 90 days, unless the client is able to continue on a self-pay basis without requiring community resource assistance. If you find that you require an extension beyond the initial 90 days, our dedicated case workers can assist you in making necessary arrangements with external agencies or family members who are willing to provide assistance.

Please feel free to reach out to us if you have any further questions or require any additional information. We are here to support you during your residency at ATP.

You do NOT have renter’s rights or any rights of tenants pursuant to the Texas Property Code, and expressly waive any such rights in exchange for membership privileges.

Fees & Charges Paid

Through various partnerships with community organizations, you may qualify for certain benefits, including assistance with rent. Unfunded days will be due within 30 days of admission of any of our homes.You will be made aware of your qualifications for such assistance upon intake and you will be notified in writing if such assistance is paid to ATP on your behalf, when it will be paid, and the length and nature of such benefits.

All fees and charges paid to third party services in which you may be required to participate, including insurance deductibles if applicable, will be disclosed to you in writing.

Drug & Alcohol-Free Residence Policy

ATP Policy prohibits the use of alcohol and illicit drugs other than prescribed medications, as well as drug-seeking behavior such as but not limited to:

Taking prescription drugs not prescribed by a physician
Taking over-the-counter medication that can produce a false positive on a drug test, specifically any ephedrine-base medication.
ATP policy also prohibits drug paraphernalia of any kind.

Any resident’s personal belongings and immediate area within the home are subject to search at any time for any reason.

Drug & alcohol testing may be required from any resident at any time, including random testing.

Urine specimen collection shall be performed by ATP Staff using a direct observation collection method.

Any resident who has knowledge of another resident’s relapse and withholds information from Staff or Management risks immediate discharge.

If a resident provides synthetic urine, tampers with a urine specimen, or has knowledge of other's tampering with a urine specimen will be grounds for immediate discharge.

It is the policy of ATP that any medication-assisted treatment medications are locked in a lockbox that is purchased by the resident prior to admission.

ATP Policy Dictates Immediate Discharge for the Following Violations:

Being under the influence of alcohol and/or drugs
Possession of alcohol and/or drugs
Threats either verbal or physical, or acts of violence, fighting
Property destruction or altering the physical construction of the premises, including the interior structure
Failure to submit a drug screen for any reason
Lying; either found on intake documentation or otherwise including failure to disclose medications or taking any scheduled narcotics including prescribed benzo's or opiates of any kind.
Stealing, unusual behavior, and/or any criminal activity
Possession of weapons
Failure to comply with the Residence Rules and/or Staff or Management direction

Refund Policy

Please be aware that all sales are final, and we do not offer refunds. However, we are committed to making sure you are satisfied with your experience—if you need support, don’t hesitate to contact us.

By signing below, I indicate that I have read and understand the Austin Turning Point Sober Living policies concerning Services, Financial Responsibility, Fees & Charges Paid, Drug & Alcohol-Free Residence, Discharge, and Refunds. I understand and accept the above conditions set forth for residency at Austin Turning Point Sober Living, and agree to abide by said conditions as a resident.

Signature*

Resident Rights

To be treated with dignity and respect.
To participate actively in your recovery.
To be given information regarding informed consent prior to the start of your stay.
Be seen by a private physician with the understanding that all costs will be the responsibility of the resident.
Have all information pertaining to their stay held in confidence.
Receive information regarding costs.
Be fully informed at the time of admission of the rights and responsibilities set forth herein and of all the rules and guidelines governing resident conduct.
Initiate a complaint or grievance procedure and understand that you may begin the process by contacting Management.
Request referral resources in the event of your dismissal from ATP.
Not to be required to perform services for ATP.
Residence Rules

All residents are required to attend 3 (three) in-person 12 Step meetings per week. This will be verified by Staff at the weekly house meeting

Within 2 (two) weeks of admission, all residents are required to:

Have verifiable employment OR be enrolled in school OR have secured a volunteer position.
Residents that are not employed, volunteering or enrolled in school are required to be out of the residence and off of the property from 10AM until 2PM, Monday through Friday. If a resident is found in their bed or at the homes during those hours, you will receive 3 (three) hours of *Community Service. This applies to all residents regardless of their personal or financial situation. If after two weeks the above has not been accomplished, residents are required to be registered at the Texas Workforce Commission and attend a 12 PM 12 Step Meeting Monday through Friday.

In order to have an overnight pass approved, the following requirements must be met:

Have been a resident for 30 days, and on Phase 2 of the Program
Have submitted a properly completed overnight pass request to a Staff Member 48 hours prior to leaving-Have no outstanding rent, community service hours, or fees due
Overnight passes are for 1 (one) night only. Any extended overnight stays are at the discretion of Management and for special circumstances only.

House meeting attendance is mandatory, which means that residents must arrange for employment that does not interfere with these meetings. There is no exception to this rule. Residents who have consistent or sporadic, non-constructive absences and/or leaving early and repeated avoidable conflicts, will be assessed by ATP Management to discuss issues regarding compliance with this policy and request that the resident comply. If this measure does not resolve the concern, then the resident will be discharged.

Weekly chore lists will be posted after the weekly house meeting. As a resident, you are expected to do your chores daily. Chores must be completed by 1100 p.m.

Be clean! Leaving dishes in the sink with/or without food, leaving personal items in living room or common areas (kitchen, bath, etc.), not bathing, not changing bed sheets weekly or being unsanitary in any way are all considered disruptive behavior and grounds for discharge.

Residents are responsible for purchasing and cooking their own food, supplying their own personal hygiene items. Residents are also responsible for their own medical care, including prescriptions. ATP will supply laundry soap, dish soap, dishwasher detergent, toilet paper, and cleaning solutions.

If a resident is the last to leave the house, they are responsible for locking both the front and back door.

The living room television is to be off between the hours of 1100 p.m. to 700 a.m., Sun.-Thurs. This is considered quiet time.

Curfew: For Phase I Residents, curfew is 10 PM, Sunday through Thursday, and 11 PM on Friday and Saturday. For Phase II Residents, curfew is 11 PM, Sunday through Thursday, and 12 AM on Friday and Saturday

Residents are responsible for doing their own laundry. All houses must use their assigned washer and dryer. Laundry must be done and removed from the washer/dryer immediately after the cycle ends. Other residents retain the right to move your laundry to a clean, out of the way location if you are unavailable to tend to it.

All house members are responsible for ensuring anonymity and friendliness within the neighborhood. Residents are to politely interact with neighbors as a member of a community, showing a positive regard should they have questions or concerns. Should neighbors have questions or concerns, they may contact the Director of Operations. There is to be no soliciting in the neighborhood.

Smoking is prohibited in the front or sides of each home. All smoking is confined to one area out of the immediate view of neighbors or adjacent properties of each home. All cigarette butts and associated refuse shall be properly disposed of in fireproof ashtrays or garbage receptacles, respectively. Butts or trash are not to be disposed of on or near any adjacent property.

Use of e-cigarettes and vaping is not permitted in the common areas of the home. Use of e-cigarettes and vaping in bedrooms is permitted with approval of a resident’s peers.

There is to be no loitering outside the home. In accordance with ATP policy on being a good neighbor, residents are to have a purpose in being outside the home on the property. Acceptable purposes may include but are not limited to landscaping, cleaning, smoking, and physical or group activities.

ATP policy dictates a peaceful, homelike environment where residents and guests alike can feel safe and comfortable at all times. Lewd and offensive language is not permitted inside or outside any ATP property and within the immediate neighborhood in which the property is located.

In keeping with ATP policy around being a good neighbor, ATP Staff will facilitate the specific responsibility of residents in keeping the exterior of the property clear of debris and trash. ATP Management will verify this once per week.

Resident vehicles are to be parked in assigned spaces and are to be in good, working condition and not create a nuisance.

Grocery shopping should be done on a weekly basis only, due to limited shelf and refrigerator space.

All meals must be eaten at the dining room table. No food is allowed in bedrooms.

After 11 PM, the kitchen is closed for cooking, including the microwave.

Bedroom placements are to be assigned by ATP Staff. If you plan on changing rooms you must first check with Staff for approval.

Visitors are not allowed in bedrooms. Visitors must stay within the common areas of the houses. Visitors must be gone by curfew, which is 10pm. Men are not allowed inside of the women's houses.

All visitors to any ATP property are subject to the Drug & Alcohol-Free Residence Policy

The use of any technology or network provided by ATP is a privilege. Viewing pornography, distasteful, or illegal websites on the house computer is not permitted.

A resident may possess one bicycle which must be locked up and kept in the backyard.

Personal electronics and appliances such as but not limited to televisions, desktop computers, grills, or coffeemakers are permitted to be brought into any ATP residence. Gaming consoles, laptops, and iPads are permitted. ATP is not responsible for any lost or stolen personal property.

Residents must notify ATP Staff within 24 hours of any prescribed medication changes.

After a resident’s discharge, with or without notice, any personal items left on the property or in the residence will be removed and either donated or disposed of 5 calendar days after discharge.

Residents that have had financial support from a family member to pay rent and/or deposits will have their family or payee contacted by ATP Management, letting them know when you are no longer a resident.

Abe Hernandez has full authority over the house as needed.

Violations of any of the rules set forth above may result in:

Verbal Warning
A resident being assigned Community Service for a length of time determined by ATP Staff
An action correction letter or behavioral contract
Changes to a resident’s Phase

Changes to a resident’s curfew
Loss of network privileges or home electronics access
Discharge and dismissal from ATP

*COMMUNITY SERVICE Residents must check in with Abe Hernandez at 512-921-8182 by 1030 a.m. the following morning that Community Service is assigned to schedule time and place to fulfill it. If a resident fails to do this, an additional hour of community service will be added.

By Signing Below I Acknowledge That I Have Read and I Agree To Abide By and Follow All of the Residence Rules

Date*

Date

Date*

Date

Signature*

Waiver of Liability

In consideration of being allowed to participate in any way in the Austin Turning Point Sober living program, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:

The risk of injury from the activities involved in this program (e.g. Stairs, ladders, lofts, or bunks), including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms of sober living. If,however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE Austin Turning Point Sober Living owner, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Signature*

Today's Date*

Date

IMPORTANT NOTICE: Austin Turning Point is a recovery home which requires expulsion, without prior notice or refund of any and all fees, of any resident member who is found to be: using alcohol or drugs engaging in disruptive behavior; in default of payment of weekly membership fee. All resident tenants of Austin Turning Point are members of our recovery home.You do NOT have renter’s rights or any rights of tenants pursuant to the Texas Property Code, and expressly waive any such rights in exchange for membership privileges. I have read the above notice and understand that I am applying for membership of Austin Turning Point as a member of a recovery home. I agree to abide by the responsibilities and requirements of the house and fully subject myself to the rules of the home, which include periodic/random drug testing. I understand that I am subject to immediate expulsion from the home if any of the following occur: I use alcohol or drugs (other than prescribed medications) I engage in disruptive behavior (continued patterns of irresponsible behavior are considered disruptive behavior) I fail to pay my weekly membership fee. By signing below, I certify that the information contained in this application is true. I have read and understand the Austin Turning Point house rules and policies. I understand and accept the above conditions set forth for membership to Austin Turning Point, and agree to abide by said conditions should I be selected as a member resident.*

I understand and will sign below

Signature Required, I've read above section and I agree*

Emergency Contact*

First NameLast Name

Emergency Contact’s Phone Number*

Please enter a valid phone number.

In case there is a relapse or other emergency situation, who would you like us to contact?*

What is their phone number?*

Please enter a valid phone number.

If you relapse or are discharged from Austin Turning Point, you will have 5 days to retrieve your belongings. In the event this happens, you must reach out to either your house manager or admissions to coordinate the retrieval of your belongings.

Signature*