I realize that the recovery house to which I am applying for residency has been established in compliance with the conditions of § 2036 of the Federal Anit-Drug Abuse Act of 1998, P.L. 100-690, as amended, which provides that federal money loaned to start the house requires the house residents to (A) prohibit all residents from using any alcohol or illegal drugs, (B) expel any resident who violates such prohibition, (C) equally share of household expenses including the monthly lease payment, among all residents, and (D) utilize democratic decision making within the group including inclusion in and expulsion from the group. In accepting these terms, the applicant excludes himself from the normal due process afforded by local landlord-tenant laws.
I certify the information I’ve given above is true to the best of my knowledge and I understand that if I have given any false information that I could be subject to dismissal from Access Foundation Recovery Residences and forfeiture of funds. I understand no onsite clinical treatment services will be provided. Supportive services will be referred to community agencies. A community resource binder will be provided for review in each of the homes. No transportation is provided. Funding for basic toiletries, bedding and linens, laundry and other basic household items will be available to each house to budget for items needed based off paid-in-full monthly rents. You are responsible for all your own shopping for and your own preparation of meals. I acknowledge Access Foundation doesn’t accept insurance as payment and doesn’t bill insurance for any services. I acknowledge and respect all rules of the program, client rights, grievance policy, critical incident & intervention reports, and discharge documentation. Acceptance of any application requires a majority vote from current tenants, based on interview and information provided. I agree to pay rent on time, if not, I will pay a late fee. Partial deposit refund will only be given with a 30 day written notice following three months of occupancy, my living space is clean and presentable, and there is no damage to the property. Deposits are returned to the depositor only. I consent to drug or alcohol testing at any time by management, house leadership team, or by any tenant in the home. I agree that I can be evicted at any time for non-compliance to the rules and will forfeit any monies paid.
I have read all the material on this application form including the limitations set forth above in the Federal Anti-Drug Abuse Act of 1998. I have also answered each question honestly and want to achieve comfortable recovery from alcoholism and/or drug addiction without relapse.
By continuing, you agree that clicking the Submit button represents your electronic signature and is the legally binding equivalent to your handwritten signature. Whenever you execute an electronic signature, it has the same validity and meaning as your handwritten signature. You will not, at any time in the future, repudiate the meaning of your electronic signature or claim that your electronic signature is not legally binding.
