guest application - thank you for your interest in joining the giveRECOVERY family. Please complete entirely! name * First Name Last Name phone (###) ### #### desired move in date MM DD YYYY date of birth MM DD YYYY current address Address 1 Address 2 City State/Province Zip/Postal Code Country social security number employment status employer name monthly income $ relationship status probation officer info (if applicable) emergency contact info are you currently sober? yes no current length of sobriety longest length of sobriety rehab treatment info substances previously used current prescribed medications and dosage medicated assisted recovery name (if applicable) primary doctor name clinic or doctor office info outpatient treatment info (location and frequency of program) mental health treatment info (location and frequency of program) why faith based recovery? are you willing to work with a sponsor through AA/NA? giveRECOVERY committment checklist I understand and agree that in order to be a participant and remain within giveRECOVERY as a Guest in the Faith-Based Recovery residence, I must be able to commit to, and complete the list of items below as required. Please check the box next to each item to ensure your understanding: Attend 5 Life-Skills/Spiritual Meetings per week Attending Weekly Religious Service Attend Weekly House Meeting & House Meal Submit to and Pass any Drug/Alcohol Tests Secure full-time employment within 30 days of move-in Follow all House Rules Thank you for submitting your application. We look forward to talking with you soon.
