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  • Financial Information

  • Chemical Use History / Legal Involvement

  • Date Format: MM slash DD slash YYYY
  • Physical / Mental Health

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  • Program Policies and Program Agreement

    Download Program Policies

    The undersigned understands and acknowledges that the above marked facility is an alcohol and drug free property managed by Sober Living Connections. The undersigned resides in the capacity of a participant sharing facility space and not as a tenant with rights or possession of space exclusively. Additionally, the participant understands that he/she waives any landlord/tenants' rights as outlined under Minnesota Chapters 504B.0001-504B.471 and may be discharged at any time for violation of this agreement. The undersigned agrees to pay a sober/security deposit of $195.00, due at the time of intake or when a spot is being held. Participant is responsible for all program fees during the course of participation.

    The undersigned participant agrees to be a part of, and abide by the policies and rules set by Sober Living Connections The undersigned agrees to vacate the shared accommodation when cardinal rules are violated. The following program policies are to be observed by all participants. These policies have been set forth by Sober Living Connections to maintain a clean, safe, and healthy living environment for those in recovery and to those who are willing and ready to change their lives and transition back into society. Any infraction of these program policies could result in disciplinary action and automatic removal from the facility. The decision to remain a participant is based on each participant's behavior, and our goals are to help each participant attain their goal of self-sufficiency by staying clean and sober and finding employment.

    1. All program fees are due on the 1st of the month, and there is no grace period. If a legitimate emergency occurs, the director shall be informed and may consent to an extension. If a participant moves from the facility under emergency circumstances prepaid service fees remaining shall be refunded on a pro-rated basis. Any failure by participant to pay fee's when due, or failure to comply with any other of the conditions of this agreement allows Sober Living Connections to immediately void this agreement. Any infraction of the program rules may result in the immediate termination of the program agreement and expulsion from the house, and forfeiture of any program fees.

    2. Standard Curfew: All participants who are working will be expected to return to the house by 12a.m. Sunday-Thursday and 1:00a.m. Friday & Saturday. Participants needs specific permission to leave any earlier than 5:00a.m. Curfews are designed to help our participants change behaviors and learn new skills.

    3. New Arrival Curfew: All new participants will return to the house by 12:00a.m. every day. New participants will abide by the Standard Curfew after initial 30 day probationary period.

    4. Medication: Our facilities do not dispense medication. Our policy prohibits taking mind-altering medications including but not limited to; scheduled drugs, controlled substances and narcotic medications however we understand that circumstances may arise that require such medications. Should this occur, participants may be discharged with a full explanation to any supervisory agencies. Any participant sharing or receiving medication will be terminated without question. All medications are subject to accountability check(s) by staff or resident managers. Participants that are found to be abusing medications such as, ingesting dosages other than what is written on the prescription label will be discharged. New prescribed medications must be disclosed to resident manager immediately.

    5. Drug and Alcohol Use: Participation is made available on the strict understanding that the house is to be, at all times, drug and alcohol free. Should a participant use any illicit drug, consume alcohol or ingest prohibited prescription drugs the participant will be discharged immediately from the program. In addition, guests or visitors of a participant who are under the influence of any type of mind altering substances are not permitted, at any time, in the house or on the grounds. Protecting and/or knowing a fellow participant is drinking or using may be cause for immediate dismissal. Reporting all suspicions to house manager is an expectation of every participant.

    6. House Liability: Sober Living Connections is not liable for any personal property during or after the participant's discharge from the house. Sober Living Connections will dispose of all personal property 24 hours after discharge. Sober Living Connections assumes no responsibility for the personal property of the participant.

    7. Payment Plans: Payment plans will be written for all participants that are $200.00 or more in arrears in program fees. They will be written by Sober Living Connections Staff and client together. Once participant agrees to plan and signs the document, the document will be enforced. Participants in arrears will be required to provide all pay stubs from their employer.

    8. No loud music. Only headphone type radios allowed. Loud and excessive noise disturbs other participants and will not be tolerated. The TV's will only be played at reasonable volume levels and violation of these rules will be considered disruptive behavior.

    9. Without director's written permission no participant will:

    • Install paneling, flooring, built in decorations, partitions or railings

    • Drill or attach anything to the floors, walls or ceiling of the house

    • Bring in any dish washing, heating, ventilating, or air conditioning units, or any water filled furniture

    • All personal property not belonging to Sober Living Connections is subject to insurance at participant's expense

    • Hang any shades, blinds and/or window guards in or outside of the premises

    • Permit the accumulation of refuse in the facility.

    10. Visitation: No visitors except for same sex sponsors/spiritual advisers. opposite sex visitors and others are only allowed at the property if they are a family member. Supervised Children are allowed on site for no more than 6 hours and may be asked to leave if any one resident reports disruption(s). Visitors are only allowed for one hour and subject to resident manager approval.

    11. Intimidation and/or violence. Any open or subtle hints of intimidation, violence or profanity towards participants or staff are grounds for immediate termination.

    12. No smoking in the house. Smoking in designated outside areas only.

    13. No sexual activity in the facility or on the facilities property.

    14. Housekeeping: Each participant is responsible for washing dishes immediately after eating. Sleeping areas are to be clean at all times. Participants are responsible for cleaning of all community living areas. Participant will keep the premises clean at all times, and upon termination will leave the premises in as good of a condition as it was when this agreement was entered. All participants are assigned weekly house chores.

    16. Excessive Utilities: Be aware of abusing free utilities. Turn off all lights in rooms not being used. Washers and dryers are available for your use. Sober Living Connections will pay all water, gas, heat, light, local telephone service, cable, and power to the house. The last person out of each facility should turn off all lights. Participants are not allowed to have hot plates, heaters, air conditioners, microwaves, small appliances or large appliances in participant rooms.

    17. Out of Bounds: Participants may not enter another person's room without permission.

    18. No Food Areas: Food will be eaten in the dining and living area only. No food in bedrooms.

    19. Passes: Participants are required to fill out a pass request form with a minimum of 48 hours notice. A minimum of thirty days in the house is required. The staff will approve all passes based on performance in the house. All program fees must be current to be approved.

    20. Work: We require all participants to volunteer, actively seek employment or work in a full or part time capacity.

    21. Sleeping: All participants must be awake, dressed, areas cleaned by 9:00 am on week days. Participants will not sleep in the living rooms.

    22. House Activities: All participants will participate in all house activities including business meetings, group sessions, and weekly housekeeping duties. Additional activities such as speaker meetings, occupational groups and/or housing network meetings. Mandatory work days for all participants may be assigned for GI duties each month if the house becomes unsanitary.

    23. Mandatory House Meeting Attendance: All participants must attend weekly house meetings. This is an important meeting that must be attended by all participants unless prior arrangement with staff has been made.

    24. Twelve Step Meeting Attendance: All participants must attend three outside published 12 step meetings per week. (AA/NA).The meeting attendance slips are to be turned in to the house manager prior to weekly house meetings.

    25. Loitering in cars by visitors and/or residents outside the facility is not permitted at any time and could• be construed as mischievous behavior resulting in discharge.

    26. Sponsorship: All participants will be required to obtain a 12 step sponsor within 14 days of program participation. We will verify with your sponsor.

    27. Outpatient Treatment Programs: All participants must attend all court, parole/probation, social services referred treatment plans. Furthermore, clients must follow all discharge recommendations from their treatment programs. Sober Living Connections may request that participants provide discharge/assessment documentation.

    28. Dress Code: All participants must be properly attired in the community areas.

    29. Pornography: No pornography and sexual aides in the facility.

    30. No pets: Participants are not permitted to have any pets on the property.

    31. Telephones: Where applicable, Participants are allowed 10 minutes maximum for each call.

    32. Weapons: No weapons of any kind are allowed on facility property.

    33. Notice to vacate: A written thirty (30) day notice of intention to discontinue participation is requested from all participants.

    34. Grievances: If a participant feels that another participant is not doing their share of the chores, or has any other grievances towards another participant, they may call a meeting with the house manager/staff with all participants to discuss the grievance. If a participant's action or behavior is found unsatisfactory by a majority of the participants at such meeting, the participant will be given the opportunity and reasonable time to change their behavior. If after two meetings the offending participant fails to make the necessary changes staff will be advised, and subject to their discretion, may terminate the program agreement.

    35. Consequences: The staff of Sober Living Connections reserves the right to enforce the following consequences for infractions of any, or all, of the above house policies. The consequences may include extra chores, restriction to the house, no passes, or discharge from the program.

    36. Vehicles: To operate and/or park a motor vehicle while residing at the facility, a valid driver's license, proof of insurance and registration are required. Copies need to be in file at the main office. They will be towed at your expense. If you own a vehicle and can't legally drive it, park it elsewhere.

    37. Room inspections: Room inspections may be carried out at any time by designated House Manager or other staff, which is subject to approval of the Director of Operations or Managing Director. Staff may search participant rooms at any time.

    38. No excessive belongings and personal items. This is a transitional program and participants should be able to fit all of their belongings into one or two suitcases. This means no televisions, personal desktop computers (Laptops are permitted) and home stereo.

  • By signing your full name below and the last four digits of your Social Security Number you agree that all information provided is true and accurate to the best of your knowledge.

    In addition, you agree, you understand, and will abide by all program policies and may be subject to program discharge for violation of any program policies.
  • Date Format: MM slash DD slash YYYY