Full Armor Ranch Sober Living Home Membership Application

Full Armor Ranch Sober Living Home Membership Application
Please ensure that you have read and understood the Full Armor Ranch Membership Agreement before signing.

FULL ARMOR MEMBERSHIP AGREEMENT

DRUG AND ALCOHOL-FREE

The undersigned acknowledges and understands that they are residing in a drug and alcohol-free shared-living environment operated by Full Armor Ranch. The undersigned is a resident in a sober home sharing a living unit, and this agreement does not grant or imply any possessory rights.

In the event that the undersigned fails to comply with the Full Armor Ranch Handbook and the Full Armor Ranch Membership Agreement, the undersigned agrees to vacate the premises within one (1) hour without the need for a formal legal process.

FEES

The undersigned agrees to pay membership of $1,000 per month for shared-living accommodations. Fees are to be paid in advance and are non-refundable. Members are expected to stay for a minimum of 30 days and up to 365 days. Extensions can be arranged if necessary.

If the undersigned moves in on a day other than the first of the month, they will pay a prorated rate for that month only.

The undersigned member expressly agrees to abide by the following rules as a condition of continued residency. This list is not exhaustive and may result in immediate permanent removal from the premises. For a current list of rules and expectations, refer to the Full Armor Ranch Handbook.

GENERAL RULES

1. No drugs or alcohol are allowed on the premises.

2. All members must be sober at all times.

3. Members are required to attend weekly house meetings.

4. Any absence from house meetings must be discussed at least 12 hours in advance with the House Manager.

5. All visitors must be approved by the House Manager.

6. Visitors are expected to follow the same rules as members while on the premises.

7. Visitors are only allowed in the common areas.

8. Visiting hours are between 4:30 p.m. and 8:00 p.m. each day.

9. All members are required to sign in and out when leaving the house.

10. Curfew is at 9:00 p.m.

11. Membership fee is $1,000 per month and is paid in advance on the 1st of each month.

12. Members are expected to submit weekly schedules to the House Manager no later than 5:00 p.m. each Thursday.

13. Members are expected to attend 40 meetings in the first 40 days after the first 40 days, a minimum of five (5) sober support meetings per week and must provide documentation of meetings attended to the House Manager.

14. Members must inform Full Armor Ranch senior staff and the House Manager of all medications they are prescribed.

15. Loud noise is not permitted after 10:00 p.m., and residents are expected to be respectful of others' need for sleep and quiet time.

16. Members must use personal headphones while listening to music at all times.

17. Members are expected to complete their assigned chores daily. Inability to complete a chore must be discussed with the House Manager.

18. Food is to be stored, prepared, and consumed in the kitchen and dining area only.

19. The kitchen shall be cleaned immediately after a meal is finished.

20. Members are expected to keep their bedrooms neat and clean at all times.

21. The House Manager will inspect rooms daily for cleanliness.

22. Do not leave personal items in shared spaces.

23. Shared spaces are to be kept neat and clean at all times.

24. Members are expected to be good neighbors, not just "non-disturbing" neighbors.

25. Smoking is not allowed in the building at any time.

26. Smoking is only allowed in designated areas between 6:00 a.m. and 9:45 p.m.

27. All cigarette butts are to be properly disposed of in the appropriate receptacle immediately after finishing.

28. Stealing and/or "borrowing without permission" is never allowed.

29. Physical violence or the threat of physical violence is never allowed.

30. No weapons, firearms, or knives are permitted.

31. Members may not borrow or loan money to/from other residents.

32. Sexually explicit materials and pornography of any kind are prohibited in all forms.

33. Lights out is 10:00pm until 6:00am.

34. Each person is allow to bring in clothes that will fit on 20 hangers as well as clothes that will fit in 2 dresser drawers.

35. Personal items are not allowed to be in common areas.

LOGISTICS

1. Full Armor Ranch staff have the right to request members to provide a urine sample or other drug test, including random alcohol and/or drug tests. Refusal to submit to testing will result in immediate discharge from the house. Canines trained for tracking drugs will be used throughout the premises on a regular basis.

2. Each member accepts full responsibility for any personal property or belongings. Items of sentimental or significant value should be kept locked in the members's storage locker, of which management will hold a copy of the lock key.

3. Full Armor Ranch house staff are not responsible for the loss, damage, and/or theft of any members' personal property or belongings.

4. Sexual activities between members or between members and their guests are not permitted in this recovery residence.

5. Neighbors: Good relations are to be maintained with our neighbors. Please conduct yourself accordingly and familiarize yourself with property boundaries. Any potential disputes should be immediately reported to staff. Do not enter the neighbors' property.

6. Provide the house manager with a 30-day notice for your planned move-out. Once a date for move-out is agreed upon, please remove all belongings and return the room to its original state by 5:00 p.m. on the move-out date. If an extension is needed, an agreement must be made in writing with the Full Armor Ranch house management.

7. If you are asked to move out of the facility due to unsafe behavior (i.e., drug or alcohol use, violent behavior, theft, etc.), you will be escorted by the Full Armor Ranch house manager to your room so that you can gather your belongings. Arrangements for picking up the remainder of your belongings (if needed) will be made with management. A surrender of your keys to the facility and your storage locker will be made at this time as well. Any personal belongings left at the house after three days past the agreed-upon move-out date will be donated or discarded without compensation.
I have read the Sober Living Membership Agreement and agree to all the policies and procedures.
Sign if you have read and agree to all the policies and procedures.

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You will need to list all the following items:

-Medications, milligrams and frequency
-Doctors names and contact information
-Current treatment information
-Probation information including phone numbers
Provide as much information as possible Incomplete appliactions will not be considered.
Name

First NameLast Name
Birth Date

MonthDayYear
Date
List any other names that you have gone by in the past include your maiden name if applicable
Phone Number
Please enter a valid phone number.
Email
example@example.com
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is this residence?
Treatment/parents home/friend/hotel etc?
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to us?

Treatment ProviderRecovery ResourceInternet SearchFriendFacebookCurrent or Past ResidentOther
Others:
Tell us about yourself. What are your hobbies or other things you enjoy doing?
Addiction History
Do you consider yourself
Primary drug of choice?
Describe your history with addiction:
In detail describe when you began experiencing problems with control and any progression that has occurred with your use of drugs and alcohol. Also describe any triggers that you are aware of.
Periods of sobriety / clean time
Describe any periods you have been able to remain clean. What did you do to achieve this / maintain this?
Involvement in 12 Step Recovery- Check all that apply

I'm currently attending AA meetingsI'm currently attending NA meetingsI attend both AA and NA meetingsI would attend meetings but cannot at this time because of treatment restrictions
Sobriety / Clean Date

MonthDayYear
Date
Sponsors Name and Phone
Leave blank if you do not have one
Check drugs abused

AlcoholHeroineMethamphetamine (Crystal)LSD / HallucinogensBarbituratesCocaineMarijuanaBath SaltsK2 or SyntheticsOther
Other:
List out triggers that you are aware of
Treatment and Mental Health History
What is your release date or date that you would like to enter sober living?

MonthDayYear
Date
Treatment Provider Name

First NameLast Name
Treatment Provider Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Treatment Provider Phone
Please enter a valid phone number.
Case Manager Email
example@example.com
Case Manager or Discharge Coordinator Name

First NameLast Name
Case Manager or District Coordinator Phone Number
Please enter a valid phone number.
Primary Therapist Name

First NameLast Name
Primary Therapist Phone Number
Please enter a valid phone number.
Please be certain to have a release of information filed so that I may inquire of your treatment team if necessary.
Mental Health
Do you have any Mental Health Diagnosis

YesNo
If you answered yes to the previous question, list your diagnosis. Include when and by whom this diagnosis was made.
Please be thorough and accurate
Are you prescribed any medications for a mental health condition

YesNo
List all medications prescribed including dosage and times daily
This information must be correct
Prescribing Doctor

First NameLast Name
Prescribing Doctor Phone Number
Please enter a valid phone number.
Medical Conditions
List all medical conditions
Blood pressure, headaches, etc.
Do you have any conditions that limit your mobility
Foot, back, leg problems, COPD, etc.
Prescribed medication list all names, dosages (milligrams) and times daily
If none- write NONE or N/A
If you have a list of current medications / prescriptions you may upload them here.

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Have you been tested for Hep C?

YesNo
Have you been tested for AIDs?

YesNo
Relationships
Marital Status

SingleMarriedCommon Law PartnerDivorcedOther
Are you currently involved in a romantic relationship or have you ended a relationship in the last year?
Relationship Status
Spouse or Partner Name

First NameLast Name
Spounse or Partner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name and age of minor children
Name and age of adult children
Level of Education
Education

No Diploma or GEDHigh School DiplomaGEDSome CollegeCollege GraduateOther
Legal Information
Criminal History check all that apply from your lifetime

I have no criminal historyI am currently on probationI have been charged with a violent crimeI have committed or have been charged with arsonI have a sex crime convictionI am on ankle monitoringOther
If you checked other please explain
If you have answered yes to any of the above questions, please state in detail the circumstances of the offense(s)
Be thorough in your explanation
County / Municipality of Probation
Probation Officer Name

First NameLast Name
Probation Officer Phone Number
Please enter a valid phone number.
Identification and Transportation
Check all that apply

I have a valid Drivers LicenseI do NOT have a valid Drivers LicenseI have my Social Security CardI have a State IDI do NOT have an ID
Do you have an operational vehicle

Yes, I have a vehicleNo, I have no vehicle
Employment
Work experience: What do you do for employment? What trades, degrees, special skills or training do you have?
List the various fields/jobs you have experience in
Are you currently employed

YesNo
Employers Name

First NameLast Name
Employers Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employers Phone Number
Please enter a valid phone number.
Are you receiving SSI or other benefits

YesNo
References

Please list two (2) references that are familiar with you life and current situation
Reference 1 Name

First NameLast Name
Reference 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 1 Phone Number
Please enter a valid phone number.
Years Known
Relationship to you
Reference 2 Name

First NameLast Name
Reference 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2 Phone Number
Please enter a valid phone number.
Years Known
Relationship to you
Upload any additional documents including DD214

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Is there any other information that you believe is pertinent to you applying for membership at one of our Full Armor Ranch sober living home locations?
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Full Armor Ranch Sober Living Home Membership Application

Addiction History

Treatment and Mental Health History

Mental Health

Medical Conditions

Relationships

Level of Education

Legal Information

Identification and Transportation

Employment

References