Date of Application: ________________
Full Name (First/MI/Last):
Date of Birth: ______________________________________
____ Verified Initials (House Manager/Program Director)
Emergency Contact(s) #:
List your Present Employer:
Employer Supervisor/Contact Person:
Have you ever been convicted of a crime? _____ Yes _____ No (If Yes, Please explain below)
Are you presently in the legal system? _____Yes _____No (If Yes, Please explain below)
List any (current) Parole or Probation Officers and contact numbers:
Are you addicted to drugs and/or alcohol? _____Yes _____No
Clean Date: _____________
Have you ever been in a Treatment Facility? _____ Yes _____No (If yes, Please explain below)
Are you taking any prescription medications? _____Yes _____ No (If Yes, Please list all medications below and reason)
ALL MEDICATIONS ARE TO BE KEPT SECURED IN A LOCKED SAFE/BOX. FAILURE TO ADHERE TO THIS MANDATORY POLICY WILL RESULT IN A FINE. RESIDENTS ARE INDIVIDUALLY RESPONSIBLE FOR THE PROVISION OF HIS/HER OWN SAFE/BOX.
Have you ever been in a Recovery House, Halfway House or similar facility? _____Yes _____No (If Yes, explain when/where)
Do you have a Sponsor? _____Yes _____ No If Yes, Sponsor’s Name/#:
Please read and initial to indicate your understanding and agreement:
____ Phoenix Recovery House membership requires a $700.00 administrative entry fee. New residents’ first two weekly rent payments are Included in this administrative fee.
____Rent is $175.00 per week, and is to be paid in full at each house meeting. Rooms are rented on a weekly basis only. Each week begins on Monday and ends on Sunday. A rent arrearage (any overdue payments) can/will result in late fees or eviction. Provided a resident departs clean/sober and in good standing (i.e., packs and carries his/her own belongings the day he/she departs, cleans his/her respective living area, does not return to the premises without permission, etc.) he/she is likely to receive a refund of any overpayment; anything less will result in a pro-rated refund or no refund at all. All refunds are given at the discretion of Phoenix Recovery LLC. Departing clients must allow at least (14) days for the processing of any refund.
____Incentive; every member that resides in a Phoenix Recovery House clean and in good standing (in Phase 2 status or higher)—for (26) consecutive weeks—is entitled to a rental credit of $175.00 to be redeemed and used only as a complimentary rent payment.
____I realize that the Phoenix Recovery House for which I am applying for residency requires complete abstinence from Drugs and Alcohol. Any use of Drugs and/or Alcohol is strictly prohibited and will result in immediate eviction from our residence(s). Disruptive and/or discourteous behavior within our residence(s) will not be tolerated and can/will result in eviction from our residence(s). Finally, a client’s inability to maintain employment and pay his/her rent in a timely manner can/will result in eviction from our residence(s). By initialing/signing, I acknowledge agreement to the terms stated, and hereby waive my right(s) to normal due process afforded by local landlord-tenant laws.
____I have read all the material on this application, and answered each question honestly. I have a sincere desire to live Clean/Sober, and achieve comfortable recovery from alcoholism and/or drug addiction without relapse. Any questions I may have had were answered to my satisfaction.
Signature: _____________________________________________________ Date: ______________________
Tenant Release Agreement
The following terms and agreement are to be read and fully understood by the undersigned tenant of the Phoenix Recovery House.
- Phoenix Recovery LLC is providing the undersigned tenant, ____________________________________, a place to reside in their recovery house located at ____________________________________________ in return for a contracted rental fee.
- The undersigned understands that they shall live in the facility under the agreed upon contractual terms and rules as provided and explained, and may terminate their residence at any time.
- Phoenix Recovery LLC provides strictly a sober living facility only and does not provide any counseling, nor restrict the undersigned from making their own personal choices as long as they do not violate facility rules as outlined in their contract for residence. Therefore, Phoenix Recovery LLC is not liable for any free will decisions made by residents, which includes but is not limited to any self-harming behaviors such as relapse, overdose, and/or death.
- Phoenix Recovery LLC will provide a housing facility in normal condition, and shall not be held liable by the undersigned for any injury or loss to the tenant, or their belongings. The undersigned, by and through their signature, acknowledges that they are responsible for any injury or accident and will forever hold harmless Phoenix Recovery LLC, unless said provider is negligent in the cause of the loss.
- The undersigned understands that Phoenix Recovery LLC carries only insurance to cover the dwelling and business assets located in the dwelling.
- The undersigned will immediately notify Phoenix Recovery LLC, in writing, of any incident resulting in injury or loss. This will include a full accounting of the incident details.
- Phoenix Recovery LLC reserves the right to amend any and all house rules or policies at any time solely at the discretion of ownership. If a new rule is created and set in motion, it will be purposeful and necessary, therefor, failure to adhere to any amended rules can/will result in eviction.
Signed and dated this ___________________________ (month) _________(day), 20 _____.
Print Name _______________________________________________
RESIDENT (signature): ____________________________________________________
PHOENIX RECOVERY LLC: _____________________________________________
Shawn Metz, Co-Founder & CEO
PHOENIX RECOVERY LLC: _____________________________________________
Kevin Mirda, Co-Founder & CEO
GENERAL HOUSE RULES/REQUIREMENTS/GUIDELINES
You are in a Recovery House which is a Sober Living Environment. Your success and continuance in this environment is dependent upon your consistent good behavior and cooperation. Disruptive and/or discourteous behavior will not be tolerated. Any contact with illegal drugs and/or alcohol and/or violation of any of the following Rules & Guidelines can/will result in eviction. Your initials and signature indicate your understanding and agreement. When in doubt…ASK!
Consumption or possession of beverage alcohol in any form is strictly prohibited.
Use or possession of illegal drugs in any form is strictly prohibited.
Use and/or possession of drugs and/or alcohol will result in immediate eviction. If evicted for drugs and/or alcohol the resident agrees to leave the premises immediately and not return for any reason whatsoever, without permission from Phoenix Recovery. Following an eviction for drug and/or alcohol use, residents have 20 minutes to pack their belongings and leave the premises. Any personal belongings left behind will be discarded after one week (7 days).
Lying, Cheating & Stealing are strictly prohibited. If caught, you will be fined and/or evicted.
Residents are required to submit to a Drug and Alcohol Screen/Test at any time (24/7) it is requested. A refusal and/or failure to provide an adequate sample will be treated the same as a positive test result. Any attempt to cheat/circumvent the test will result in eviction.
Daily attendance to “12-Step” meetings is strongly encouraged/recommended; the minimum weekly requirement for meeting attendance is (3) per week. Acceptable meeting attendance is seated & present prior to the opening prayer, present for all readings as well as the meeting itself up until and after the closing prayer has concluded. ARRIVE EARLY, STAY LATE! MEN WITH MEN, WOMEN WITH WOMEN! & D.U.M.F
Residents are required to maintain a Home Group.
Residents are required to get and maintain a working relationship with a Sponsor.
Residents are required to maintain employment. If at any time a client is/becomes unemployed and is capable of working (not injured or sick), he/she must be out of the house actively seeking employment from 9:00 am - 2:00 pm Monday through Friday, and is not permitted at the house during this time. Failure to abide by this rule will result in a fine and/or resident restriction. A resident’s employment is prohibited from interfering with their adherence to any of the other terms of this agreement.
All residents are required to be awake and out of bed no later than 9:00 am Monday – Friday. Any house member reported still sleeping past this time can/will be subjected to a fine. The only exception to this rule is a house member who works a documented late night or overnight shift.
Behavior considered to be a “Conflict of Interest” (i.e., Sponsorship, Employment, Dating, etc.) between residents is strictly prohibited. NO DATING OR VISITATION BETWEEN RESIDENTS/HOMES OF THE OPPOSITE SEX WITHOUT VERBAL PERMISSION FROM PHOENIX RECOVERY MANAGEMENT.
Smoking inside any Phoenix Recovery home is strictly prohibited, failure to abide by this rule will result in the maximum fine/or eviction.
Phoenix Recovery LLC is NOT (at any time) responsible for a resident’s personal item’s/belonging(s). Residents are responsible for the security and safekeeping of their own personal item’s/belongings and are to pack and carry their item’s/belongings when they depart or when membership from the house has been terminated. If for any reason this does not occur, the resident may contact the House Manager or Phoenix Recovery regarding the retrieval/disposition of their personal item’s/belongings. Phoenix Recovery will not store personal belongings for more than one week (7 days). Any item(s) left in the house following this period will be discarded.
Disruptive/Discourteous behavior will not be tolerated and can/will result in eviction.
Possession of weapons and threats of violence towards other house members is strictly prohibited and will not be tolerated.
Overnight guests are strictly prohibited during blackout and resident restriction periods. Any girlfriend/boyfriend or significant other who stays past midnight (12:00 am) Monday – Thursday or 1:00 am Friday & Saturday will be considered an overnight guest. An environment which is conducive towards recovery is to be maintained at all times. Guests coming and going all hours of night is not necessary nor tolerated.
Personal guests are not permitted at the house beyond curfew.
Guests cannot be under the influence or in possession of drugs and/or alcohol.
New Resident blackout curfew is 11:00 pm Sunday – Thursday, 12:00 am Friday & Saturday. Once off New Resident status (Phase 1), all others’ must be in by 12:00 am Sunday through Thursday and 1:00 am Friday & Saturday. You must adhere to the curfew and privileges of whichever Phase you are currently on while living in the house. However, residents must abide by stricter curfews when required (i.e., Parole, Probation, etc.) regardless of which Phoenix Recovery Phase a resident may have been granted. Failure to return to the house on time can/will result in restriction or eviction.
House quiet time is 11:00 pm to 5:00 am. Any activity (i.e., lights, loud TV, telephone conversations, music, etc.) that disturb another resident’s ability to sleep/rest is prohibited. Be respectful and mindful to other house members.
Evicted Residents have 20 minutes to pack their belongings and are required to leave the premises immediately and not return under any circumstances.
House Business Meetings are held weekly at a date/time determined by Phoenix Recovery LLC and are mandatory for every member. An unexcused absence from any House Meeting can/will result in a fine/restriction and possible termination. Work, 12-step meetings, and/or personal obligations are prohibited from conflicting with the weekly house meeting.
Residents are not permitted in any bedroom other than their own without permission from the resident(s) residing in that room; they must also be accompanied by the permitting resident.
Thermostat is to be adjusted by the House Manager or most senior house member only.
Washer & Dryer -- Be courteous. Clean dryer lint screen before and after every use and do not leave clothes unattended in the washer/dryer. If a House Manager has created a laundry schedule, that is to be adhered to.
Chores are required to be completed in full weekly. House members are required to upkeep their assigned chores at least once per day. The Chore Coordinator is responsible for chore assignment and completion. Failure to complete assigned chore can/will result in a fine.
A good General Clean-up of all areas inside & outside the home is required at all times. If it reported that dishes are being left in the sink, Garbage/Recycling is not being maintained, or cigarettes are not being disposed properly, the entire house can/will be fined.
Beds are required to be made upon awakening. Respective areas are to be kept neat, clean and picked up at all times. NO SLOBS; YOU CAN/WILL BE FINED!
Turn off lights, TV’s, Radio’s, Fans, etc., when not in use. Exterior doors are required to be closed and locked when entering/exiting; no exceptions!
DOORS; Residents are prohibited from locking bedroom doors. THIS IS A MUST. Any member who attempts to lock their bedroom door can/will be fined/evicted. Any resident who gives the front or back door keypad access code to any non-house member will IMMEDIATELY be evicted.
Sleeping in common areas is prohibited.
Kitchen—Appliances, Counter-tops, Utensils, Dishes, Pots, Pans, etc. will be cleaned and returned to their respective place (immediately) after each use.
Refrigerator—Mark food/leftovers with Name/Date when initially placed in the refrigerator(s).
All prescribed Medication(s)/controlled substances found to be abused by a house member will result in eviction!
A violation of any one of the aforementioned Rules & Guidelines can/will result in a fine or eviction. Fines range from as little as $25, up to a full $100. Once a fine has been given, the fine amount is automatically added to the resident’s weekly rent balance.
Signature: _______________________________________ Date: ___________________, 20___.
New Client Blackout & Resident Restriction
Resident’s Name: _______________________________________________
Every “new resident” entering a Phoenix Recovery House must adhere by any and all conditions of the new resident blackout period. Phoenix Recovery House requires strict adherence to these conditions as well as all Rules & Guidelines. While on blackout:
- Attend an NA/AA or 12-step meeting daily (minimum 3 per week).
- Have a Sponsor (Residents are required to maintain a working relationship with a Sponsor).
- Have, attend and participate in a Home Group.
- Have and fulfill a Service commitment within the 12-Step fellowship you attend.
- Adhere to a 11:00 pm curfew Sunday – Thursday, and a 12:00 am curfew Friday & Saturday (If attendance to an evening “AA/NA” meeting is desired, you MUST be accompanied by another Phoenix Recovery House resident who is Phase 1 status or higher). Arriving home after curfew is not tolerated and thus will result in an extended blackout period. A second offense will result in IMMEDIATE expulsion. This rule is NOT NEGOTIABLE.
- NO GUESTS allowed in the house while on new resident status until employment has been obtained. Once employment has been secured, one (1) guest per week is permitted in the house while on blackout.
- Be employed within two (2) weeks & have satisfied all financial obligations.
- 30 days is the minimum for a new resident blackout period, after this time, members in good standing will be up for Phase 1 review.
- Satisfy all conditions of your agreement with Phoenix Recovery House. A client will remain on new client status until all conditions of his/her agreement with Phoenix Recovery LLC are met/satisfied. If at any time a client violates the conditions of his/her agreement within Phoenix Recovery House, their blackout period will automatically be extended.
- RESTRICTION: Residents who are on either Phase 1, 2, 3 or 4 statuses, but fail to adhere to the Rules & Guidelines of the house will be placed on RESTRICTION. While on restriction you must follow the guidelines of BLACKOUT for an allotted period of time.
Note: You are encouraged to become thoroughly familiar with all Rules & Guidelines and the conditions of your agreement with Phoenix Recovery. Ignorance is not an excuse!
Client Signature: _________________________________________ Date: ________________, 20____
I ___________________________________, understand that I can be tested for Drugs and/or Alcohol at any time, for any reason, per my agreement with Phoenix Recovery House. I am aware and have full knowledge that the person(s) administering the test(s) are my peers and not medical personnel. I am also aware that if I test positive, refuse compliance or attempt to cheat/circumvent the test in any way, I will be evicted from the Phoenix Recovery House and required to leave the premises immediately. My signature below indicates my understanding and consent.