Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of BirthGenderMaleFemaleOtherAre you a VeteranYesNoHow will you pay?I will pay myselfSomeone else will payOtherAre you in aftercare (IOP, OP, Therapy)?YesNoDo you have an issue with sharing a room?YesNoAre you able to perform household chores?YesNoEmail *Best phone number to reach you?Current AddressEmergency Contacts (with contact info)I have currently have insuranceYesNoInsurance Provider and Member ID:Date of last use?Do you have any health issues?Do you have a history of SeizuresYesNoDo you have any physical health or medical conditions?YesNoDo any of the following apply to you?Hepatitis AHepatitis BHepatitis CImmune System DisorderSexually Transmitted Diseases (STDs)Tuberculosis (TB)PregnancyNone ApplyAre you currently under the care of any of the following provider types?Medical DoctorPsychiatristPsychologistTherapistNutritionistDo you require any medical equipment? (If so, please list below)Eg. Walkers, Sleep Aids etc...Are you currently taking any Medications (if so, please list below)Please includes dosage and frequencyPlease list any treatment centers you have attended in the past:Please list all sober living Programs you've resided in:I am currently employed:YesNoPlease provide your most recent employment history?Please include dates and contact information if availableLiving Arrangement History:Please provide your most recent living situation with dates.I consent to background checkYesNoAre you currently involved in any legal proceedingsYes/No. If yes, please describe with current status.Do you currently have a requirement for community service?Do you have any court ordered Treatment requirements?Do you have any pending sentencing or possible jail time coming up?Have you ever been charged or convicted of Arson?yesNoHave you ever been charged or convicted of a Felony?YesNoHave you ever been charged or convicted of any violent crimes in any jurisdiction?YesNoHave you ever been charged or convicted of any violent of abuse or neglect of any person, including but not limited to disabled persons, seniors, or children?YesNoAre you required to register as a sex offender?YesNoAre there any restraining orders against you or by you?YesNoAre you required to register with any other authority for any other reason?When would you like to move in?Client StatementWhy do you want to live in a Sober Home? What other information should we consider when looking to approve your application?What are your goals and aspirations from a sober living program?Why do you think you are a good fit for sober living? What do you want to accomplish while residing at Princeton Sober Living?Submit Resident Agreement Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastDrug Test DateDeposit AmountMove In DatePrevious AddressCurrent AddressDate of BirthI have a Drivers LicenseYesNoDrivers License Number:Emergency Contact InfoPlease include, name, relationship and contact information.Multiple ChoiceFirst ChoiceSecond ChoiceThird ChoiceCurrent EmployerPlease include, location, contact/supervisor, and contact information.Have you ever been convicted of a crimeYesNoAre you a registered sex offenderYesNoAre you currently involved in any legal proceedingsYesNoI don't knowParole or Probation OfficerIf applicable, list all current parole or probation officer contact information (name and phone number).Are you addicted to drugs or alcoholYesNoDate of last use Sobriety dateSingle Line TextTreatment Center HistoryPlease list the last treatment center you attended with the location, date of discharge and length of stay (approximately).Reason for leavingPrevious Treatment Center HistoryPlease list all treatment centers you have attended in the past with as much information as possible.Are you currently taking any prescribed medicationsYesNoDosageQuantityFrequencyCurrent Medication InformationPlease describe the reason for this medication and as much information as possible. Additional MedicationsPlease list all medications that you are taking with as much information about each medication as possible.Previous Sober Living HistoryIf applicable, please list your most recent experience in a sober living facility. Include: Sober Living Name, Location, Length of Stay, Date of Discharge and Reason for leaving.Do you have a sponsorYesNoTerms and ConditionsBy checking this box I understand and agree to the following: Princeton Sober Living requires a $300.00 (non refundable) admin fee and first 2 week's rent($450.00 - non-refundable) to move in. These are non-refundable.By checking this box I understand and agree to the following: That rent is $225.00 weekly. Rooms are rented by the week or month only. Residents—specifically those in arrears—can make daily monetary payments in any sum/amount. To make a payment, see the house manager and ensure receipt is provided. Each week begins on Sunday and ends on Saturday. A rent arrearage can/will result in eviction. Provided a client departs sober and in good standing (i.e., packs and carries his/her own belongings the day he/she departs, washes and places linen back on his/her bed, cleans his respective living area, does not return to the premises without permission, etc.) they are likely to receive a refund of any overpayment; anything less will result in a prorated refund or no refund at all. All refunds are given at the discretion of Princeton Sober Living. Departing clients must allow at least (14) days for the processing of any refund. There is a 10% late fee if the rent isn't on time.By checking this box I understand and agree to the following: Princeton Sober Living, 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) or community 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 checking this box, I acknowledge agreement to the terms stated, and hereby waive my right(s) to normal due process afforded by local landlord-tenant laws.Item 4DateTenant Release AgreementBy checking this box I am acknowledging that I have read and understood the following terms and conditions: 1. Princeton Sober Living is providing me, , a place to reside in their sober living house located at: 2116 Lawrenceville Rd, Lawrenceville, NJ 08648, in return for a contracted rental fee. 2. I shall live in the house under the agreed upon contractual terms and rules as provided and explained, and may terminate their residence at any time. 3. Princeton Sober Living is providing a sober living house only and does not provide any counseling, nor restricts me from making my own personal choices as long as they do not violate facility rules as outlined in their contract for residence. 4. Princeton Sober Living will provide housing in normal condition, and shall not be held liable by me for any injury or loss to me, or my belongings. I acknowledge that I am responsible for any injury or accident and will not hold Princeton Sober Living responsible, unless said provider is negligent in the cause of the loss. 5. I understand that Princeton Sober Living carries only insurance to cover the dwelling and business assets located in the dwelling. 6. I will immediately notify the Princeton Sober Living house manager, in writing and verbally of any incident resulting in injury or loss. This will include a full accounting of the incident details.DateGeneral House Rules/Requirements/Guidelines. By Checking this box I acknowledge that I am choosing to live in a Sober Living House/Environment. I agree that my success and continuance in this residence is dependent upon my 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.I agree that consumption or possession of beverage alcohol in any form is strictly prohibited.I agree that 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 the House Manager.I understand that lying, Cheating & Stealing are strictly prohibited. If caught, offenders will be fined and/or evicted.I understand that residents are required to submit to a Drug and Alcohol Screen/Test at any time (24/7) if it is requested. A refusal or failure to provide an adequate sample will be treated the same as a positive test result. A 2 hour window is granted to submit a urine sample upon request. Any attempt at a Cheat/Circumvent test will result in a fine/eviction.I understand that daily attendance at “12 Step” meetings is strongly encouraged/recommended; the minimum daily attendance requirement is (4) per week mandatory on blackout and 3 when your off blackout. When you are on blackout you MUST have a signed meeting list as proof of attending the meeting. Acceptable meeting attendance is seated & present prior to the Serenity prayer, present for all readings as well as the meeting itself up until and after the Lord ’s Prayer is concluded. ARRIVE EARLY, STAY LATE! MEN WITH MEN, WOMEN WITH WOMEN!I understand that residents are required to be engaged in recovery treatment; IOP, OP, Recovery based meetings, etc.I understand that residents are required to maintain a working relationship with a Sponsor. Residents must have a temporary sponsor to get off of blackout status.I understand that residents are required to maintain employment/volunteering If at any time a client is or becomes unemployed and is capable of working (not injured or sick), they must actively seek employment from 8:00 am - 5:00 pm Monday through Friday, and is not permitted at the house during this time. A resident’s employment is prohibited from interfering with their adherence to any of the other terms of this agreement.I understand that Princeton Sober Living is NOT (at any time) responsible for a resident’s personal items or belonging(s). Residents are responsible for the security and safekeeping of their own personal items or belongings and are to pack and carry their item’s/belongings when they depart. If for any reason this does not occur, the Resident may contact the House Manager regarding the retrieval or disposition of their personal items or belongings. Princeton Sober Living will not store personal belongings for more than seventy-two (72) hours.I understand that disruptive/discourteous behavior will not be tolerated and can/will result in eviction.I understand that overnight guests are strictly prohibited unless the guest is a resident’s child and approved by the House manager.I understand that guests are not permitted at the house beyond 8:00 and are only permitted in the common areas.I understand that residents are ONLY permitted to use toilet paper in the toliets. NO tampons, wipes ( even if they say flushable they aren’t flushable ever) Failure to comply will result in a fine and possible water shut off to repair plumbing pipe.I understand that Princeton Sober Living is not responsible for resident’s vehicle. Cars must be parked in a safe appropriate space. See house manager for details.I understand that curfew is 10:00pm while on new resident status, 11:00pm every night Sunday through Thursday and 12:00am Friday and Saturday after 30 days. Overnights are allowed twice a week. Residents must adhere to more strict curfews when required (i.e., Parole, Probation, etc.). Failure to return to the house on time can/will result in eviction. This applies to residents that are not on New Resident status.I understand that house quiet time is 10:00pm to 6:00am. Any activity (i.e., Lights, TV, Telephone conversations, etc.) that disturb other residents’ ability to sleep/rest is prohibited. Violators may be fined.I understand that evicted Residents are required to leave the premises immediately (15 min) and not return under any circumstances.I understand that previous residents of Princeton Sober Living that have relapsed must have a clean drug test before being able to visit any Princeton Sober Living properties. Another member of the house must be present ( a total of 2 housemates ) for accountability purposes.I understand that weekend leaves are allowed but only 2 days per week. If gone 2 consecutive days a Drug test must be submitted upon returning.I understand that 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.I understand that 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.I understand that the thermostat is to be adjusted by the House Manager only.I agree to clean dryer lint screen before and after every use and do not leave clothes unattended in the washer/dryer.I understand that no resident will be fined during New Resident status unless there are recurring incidents that have been addressed but not corrected. (First 30 day)I understand that chores are required to be completed daily. The House Manager is responsible for chore assignment and completion. Failure to complete assigned chores can/will result in fine, Curfew reduction, or eviction.I agree to turn off lights, TV’s, Radio’s, Fans, etc. when not in use. Exterior doors are required to be locked when entering/exiting the house. Violators will be fined. No exceptions!I understand that sleeping in common areas is prohibited.I agree that appliances, Countertops, Utensils, Dishes, Pots, Pans, etc. will be cleaned and returned to their respective place (immediately) after each use.I agree to mark food/leftovers with Name/Date when initially placed in the refrigerator.I understand that Princeton Sober Living residents are not permitted on any other property within the community without permission from the owner of the property.I understand that any resident caught using/possessing any prescribed Medication/controlled substance unknown to the House Manager or exceeding (1) day dosage of prescribed medication/controlled substances will be evicted!I agree to be Accountable, Responsible and Communicate! Accountability and Communication eliminates the need for excuses with the House Manager.I understand that there is “Zero tolerance” of physical violence or threats of violence. Verbal abuse towards fellow residents or staff is also prohibited. Any violations will result in immediate termination and police will be notified if necessary.I understand that pets of any kind are NOT allowed. If a pet is brought in and or cared for in any way; violators will be evicted immediately.I understand that all new residents and Contract residents Must text in and out when entering or exiting the house. No exceptions.I understand that random room checks will be conducted to ensure there is no contraband and kept clean and tightly. No exceptions.I understand that residents on Contract will have extra duty chores until the contract expires.I understand that in the event of a relapse emergency contacts can and will be informed of relapse and eviction.I agree that while residing at Princeton Sober Living please I will treat all property with respect. I will be held financially responsible for any damage to Princeton Sober Living property or grounds that occur as a result of my negligence or inappropriate behavior. Intentional destruction of property is grounds for immediate termination and police will be contacted if appropriate. Any theft will result in immediate eviction.I understand that Princeton Sober Living provides furniture in the house as well as bedding, cooking and eating utensils. Residents are responsible for providing their own food and personal items. The house will collect $10.00 from each resident on the 1st Saturday of each month and use the collected funds for purchasing commonly used goods as needed for that house (toilet paper, paper towels, garbage bags, dishwashing detergent, cleaning supplies, etc). It is still each resident’s responsibility to ensure they have what is needed during their stay.I understand that I am required to provide verification of full-time employment (minimum of 40 hours a week). If you are attending school, volunteering and/or working part-time, you are also required to provide verification of these activities and singularly or in combination they must total 40 hours per week. (IOP program hours can be part of these 40 hours). Clients must be up and ready to go by 8:00AM every morning without exception. Failure to meet this requirement will result in immediate eviction.I understand that each house will have an assigned house manager that will be the responsible party for each house. The resident will direct any/all issues and requests to the house manager. House manager will issue all directives and or responses which need to be followed by all residents. If the resident feels that his house manager is not being reasonable or feels that the issues or questions are not being addressed, the resident is to make direct contact with the Executive Manager immediately. House Managers have specified authority to certain decisions and will directly seek the Executive Manager for approval on all others.I understand that if any resident knows that a fellow resident used any substance and doesn’t inform the House Manager Immediately will be placed on contract, fined, or evicted.I understand that residents in any type of treatment must sign a release for the House Manager to have access to UA records and treatment progress.I understand that I can be tested for Drugs and/or Alcohol at any time, for any reason, per my agreement with Princeton Sober Living. 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 Princeton Sober Living and required to leave the premises (15 min) immediately.It is the policy of the Princeton Sober Living to ensure equal housing opportunity without discrimination or harassment on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, age, disability, marital status, citizenship, genetic information or any other characteristic protected by law. Princeton Sober Living prohibits any such discrimination or harassment. Princeton Sober Living is designed to assist adults with a history of problems with alcohol and/or substance use. These services are for those serious about their recovery and seek additional support and safety that a structured sober living community offers. This has been shown to be a key support for making a successful reintegration to independent living. Residents participate in community-related sober activities while working, volunteering, or continuing their education. All residents make a minimum 3 month commitment with 6 months being recommended. Submit Drug Screen Consent Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastI understand that I can be tested for Drugs and/or Alcohol at any time, for any reason, per my agreement with Princeton Sober Living. 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 Recovery House and required to leave the premises (15 min) immediately. I AgreeDate / TimeDateTimeSubmit Waiver Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Notice: This form contains a release and waiver of liability and when signed is a contract between the undersigned participant and Princeton Sober Living with legal consequences. Please read this Agreement, consisting of one (1) page in its entirety, carefully before signing your name at the bottom of the page. This form must be signed in the presence of one (1) witness who should sign as witness. Date of Execution of Release and Waiver of Liability: The undersigned agrees that this “Activities Release and Waiver of Liability” form agreement is valid from the date of execution through the date of discharge. Acknowledgments and Representations by Client:The undersigned is currently a client of Princeton Sober Living The undersigned has voluntarily consented to participate in normal daily activities such as walking down stairs, taking a shower, voluntary sports activities or voluntary physical activities such as volleyball, aerobics, and other such types of voluntary sports or physical activities, which may not be specifically identified herein, while being a client at such facility. The undersigned acknowledges and represents that his participation in such sports activities and physical activities is not a mandatory requirement of Princeton Sober Living, and that any participation by the undersigned in any and all sports related activities and physical activities, is purely voluntary and of the undersigned’s own free will. The undersigned acknowledges and represents that there has been no coercion or force on the part of Princeton Sober Living for the undersigned to execute this release and waiver of liability agreement. The undersigned has knowingly, freely and voluntarily consented to execute this release and waiver of liability agreement. The undersigned acknowledges and understands that it is the undersigned’s sole decision to participate in such voluntary activities. The undersigned acknowledges and represents that he/she has been informed that he/she has an absolute right to refuse to participate in any and all sports related activities or physical activities. To Princeton Sober Living: In consideration of the opportunity afforded to me, by Princeton Sober Living, to participate in voluntary sports activities or voluntary physical activities such as volleyball, aerobics, and any other similar types of voluntary sports or physical activities which may not be specifically identified herein, the undersigned client freely agrees to make the following contractual representations and agreements with Princeton Sober Living. The undersigned client, does hereby knowingly, freely, and voluntarily assume all liability for any damage or injury that may occur as a result of my (or my dependent/ward) participation in the activities described herein and agree to release, waive, discharge, and covenant not to sue Princeton Sober Living, its officers, agents, employees, and volunteers from any and all liability or claims that may be sustained by me or a third party directly or indirectly in connection with, or arising out of participation in the activities described herein, whether caused in whole or in part by the negligence of Princeton Sober Living, or otherwise. The undersigned client, has read this form, fully understand its terms, and understand that, I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of any and all liability to the greatest extent allowed by law, and I agree that if any portion of this contract is held to be invalid the balance notwithstanding, shall continue in full legal force and effect. I also agree that the rules provided to me by Princeton Sober Living, will be followed during the course of my voluntary participation in the activities and or normal daily activities described herein. Otherwise, my privilege of participating in such activities will be revoked immediately. Each client must sign a release and waiver of liability form in order to participate in the voluntary activities or reside at Princeton Sober Living described herein. I acknowledge that due to the nature of the activities described herein, Princeton Sober Living staff will not be able to prevent injuries from occurring during the course of such activities; therefore, I am choosing to participate in such activities at my own risk and agree to assume all risks associated therewith. Indemnification of Princeton Sober Living:The undersigned client shall at all times hereafter indemnify, hold harmless and, at Princeton Sober Living Attorney’s option, defend or pay for an attorney selected by Princeton Sober Living to defend Princeton Sober Living, its officers, agents, servants, and employees against any and all claims, losses, liabilities, and expenditures of any kind, including attorney fees, court costs, and expenses, caused by negligent act or omission of the client, other clients, Princeton Sober Living, its employees, agents, servants, or officers, or accruing, resulting from, or related to the undersigned client engaging in any voluntary sports activities or voluntary physical activities such as volleyball, aerobics, and any other similar types of voluntary sports or physical activities which may not be specifically identified herein, including, without limitation, any and all claims, demands, or causes of action of any nature whatsoever resulting from injuries or damages sustained by any person or property. The provisions of this section shall survive the expiration or earlier termination of this Agreement or the discharge of the client from the residential/outpatient facility operated by Princeton Sober LivingI AgreeName *FirstLastSubmit Rules Agreement Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLast1. All clients must make a minimum of 4 self help meetings a week. 2. All clients must have a sponsor, home group and commitment in the first 30 days in order to get off of Blackout. 3. All clients must sign a Release of Information form for their UA results if they are attending any IOP or OP sessions. 4. All clients that are not employed must make 7 meetings per week 1 meeting per day at the least. 5. All clients with a history of overdose must be on the Vivitrol shot at least the first 6 months at Ryse Recovery. 6. All clients must start step work after 30 days after admitting to Princeton Sober Living. This client understand that if these requirements are not met I am subjected to administrative discharge. By continuing, you agree that your electronic signature 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.I have read and understood the above rulesSubmit Negative Test Results Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastThis is to certify that I received a negative result for my urine screen.AgreeDate / TimeDateTimeSubmit
