Name
Gender
Are you a Veteran
How will you pay?
I have currently have insurance
Do any of the following apply to you? (Select all that apply)
Are you currently under the care of any of the following provider types? (Select all that apply)
Eg. Walkers, Sleep Aids etc...
Please includes dosage and frequency
I am currently employed:
Please include dates and contact information if available
Please provide your most recent living situation with dates.
I consent to background check
Yes/No. If yes, please describe with current status.
Have you ever been charged or convicted of Arson?
Have you ever been charged or convicted of a Felony?
Have you ever been charged or convicted of any violent crimes in any jurisdiction?
Have 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?
Are you required to register as a sex offender?
Are there any restraining orders against you or by you?
Why do you want to live in a Sober Home? What other information should we consider when looking to approve your application?
Why do you think you are a good fit for sober living? What do you want to accomplish while residing at Princeton Sober Living?
Name
I have a Drivers License
Please include, name, relationship and contact information.
Please include, location, contact/supervisor, and contact information.
Have you ever been convicted of a crime
Are you a registered sex offender
Are you currently involved in any legal proceedings
If applicable, list all current parole or probation officer contact information (name and phone number).
Are you addicted to drugs or alcohol
Sobriety date
Please list the last treatment center you attended with the location, date of discharge and length of stay (approximately).
Please list all treatment centers you have attended in the past with as much information as possible.
Are you currently taking any prescribed medications
Please describe the reason for this medication and as much information as possible.
Please list all medications that you are taking with as much information about each medication as possible.
If 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 sponsor
Terms and Conditions
Tenant Release Agreement
Name
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 Recovery House and required to leave the premises (15 min) immediately.
Date / Time
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 Living
Name
Name

Resident House Rules & Acknowledgment

Instructions: Please read each section below carefully. Check the acknowledgment box after each section to confirm that you have read, understand, and agree to comply with those rules.

Admission & Residency

  1. Residents must remain committed to a substance-free lifestyle.
  2. Residents must sign and abide by all house rules.
  3. Residents must provide emergency contact information.
  4. Residents must pay program fees/rent on time at corresponding house meeting.
  5. Residents must participate in house meetings.
  6. Residents may not spend time at opposite gendered sober living outside of Princeton Sober Living scheduled events for fellowship and community building (e.g. game nights, BBQs, community dinners with staff present, etc.).
Admission & Residency — Acknowledgment

Sobriety

  1. Zero tolerance for alcohol or illicit drug use.
  2. Any relapses require medical clearance prior to being allowed into the sober living.
  3. Treatment center will be informed of this relapse and all clinical recommendations must be followed to maintain good standing within sober living.
  4. Monetary charge of up to one week of rent as a return fee for any relapses.
  5. Possession of alcohol, illegal drugs, drug paraphernalia, or misuse of prescription medication is prohibited.
  6. Residents are required to adhere to a minimum of weekly alcohol and drug screening tests. These may be requested at any time, randomly or based on suspicion.
  7. Residents are expected to breathalyze on a nightly basis and based on suspicion.
  8. Refusal to test may be treated as a rule violation.
Sobriety — Acknowledgment

Prescription Medications

  1. All prescription medications must be stored in individual lockboxes.
  2. Medications must be taken only as prescribed.
  3. Medications must be disclosed to and approved by medical staff prior to being stored in individual lockboxes.
  4. Medications are subject to random compliance counts.
  5. Any narcotic medications or medications identified by clinical/medical staff as a safety risk must remain within a locked cabinet and must be observed.
  6. Sharing or selling medications is prohibited.
Prescription Medications — Acknowledgment

Recovery Expectations

  1. Attend all required treatment sessions (PHP, IOP, OP, therapy, MAT appointments, medical appointments, etc.).
  2. Attend 4 recovery meetings (AA, NA, SMART Recovery, etc.) per week for the first 30 days. This requirement drops to 3 following blackout period.
  3. Residents in blackout period are required to attend meetings with recovery tech or house manager as a group.
  4. Obtain and maintain a sponsor or recovery mentor within 30 days if working a 12-step program. House managers must meet your sponsor.
  5. Obtain a home group within 30 days.
  6. Residents must obtain a job or volunteer opportunity by 60 days of residence.
  7. Residents agree to participate in recovery-related activities and integrate into the sober living community.
Recovery Expectations — Acknowledgment

Curfew

  1. Sunday–Thursday: 10:00 PM (blackout), 11:00 PM (after 30 days).
  2. Friday–Saturday: 11:00 PM (blackout), 12:00 AM (after 30 days).
  3. Curfew does not apply when attending work or recovery-related activities. Any conflicts in these categories must be reviewed by staff prior to approval (e.g. meeting list with times, work schedule provided to staff for review).
  4. Residents may leave for reasonable errands or approved activities.
Curfew — Acknowledgment

Overnight Passes

  1. Overnight passes are not allowed within the first 60 days of residence.
  2. After 60 days, residents may be granted one overnight pass per week.
  3. Date, time, and location of the overnight must be shared with staff.
  4. A family session or contact must occur with the person identified prior to the overnight pass being approved.
  5. Resident must have been in good standing with all rules and recovery expectations for the past 60 days, including but not limited to meeting attendance, having a sponsor, job or volunteer engagement, treatment engagement, and being current on rent.
  6. Falsification of overnight information is subject to disciplinary actions, up to and including eviction from Princeton Sober Living.
  7. Exceptions for one pass per week must be discussed and approved with clinical and housing staff.
  8. Emergencies requiring residents to leave housing must be communicated as soon as possible. Documentation around an emergency may be requested by housing or clinical staff prior to returning to sober living where applicable.
Overnight Passes — Acknowledgment

Visitors

  1. Visitors are limited to immediate adult family members only (e.g. parents, siblings, adult children, spouses/long-term partners).
  2. No visitors for the first 14 days of residency.
  3. Visitors are allowed Sundays from 12:00 PM–2:00 PM.
  4. Prior to a family member visiting, they must have engaged in 1 family session with the client’s therapist and attend 1 virtual family group.
  5. Visitors are restricted to common areas.
  6. Overnight guests are prohibited.
  7. Visitors may not bring alcohol or drugs onto the property.
  8. Residents are responsible for their guests’ behavior.
Visitors — Acknowledgment

Employment & Daily Responsibilities

  1. Residents are expected to seek employment, attend school, volunteer, or otherwise engage in productive daily activities unless medically excused.
  2. Residents must communicate work schedules to house management.
  3. Residents are expected to meet these conditions by day 60 of residency in the sober living. This requirement is subject to change based on clinical recommendations and progress.
  4. Residents are expected to engage in behaviors that support obtaining a job, volunteer position, or school commitment from 9:00 AM–3:30 PM Monday–Friday if not otherwise engaged in treatment sessions or recovery-related activities. Housing staff reserves the right to request documentation supporting reported behaviors at any time (e.g. job applications submitted, homework completed, research done, interviews scheduled, etc.).
  5. Residents must apply to 5 jobs per day if pursuing employment.
  6. Residents who do not meet these conditions may be asked to leave the sober living.
Employment & Daily Responsibilities — Acknowledgment

House Responsibilities

  1. Complete assigned chores on a weekly basis.
  2. Maintain clean bedrooms and common areas.
  3. Report maintenance concerns promptly.
House Responsibilities — Acknowledgment

Respect & Conduct

  1. Treat fellow residents and staff respectfully.
  2. No violence, threats (verbal or physical), harassment, bullying, or intimidation.
  3. No discriminatory behavior is tolerated.
  4. No recording fellow housemates or house meetings to maintain confidentiality and safety in the sober living.
  5. Practice confidentiality about your housemates when speaking to people outside of the sober living.
  6. Maintain appropriate boundaries with other residents.
  7. Fraternization is strictly prohibited. Suspected fraternizing behaviors are subject to immediate behavioral contract initiation. Further behaviors witnessed or reported may lead to referral to other sober living resources.
Respect & Conduct — Acknowledgment

Property Rules

  1. No weapons.
  2. No gambling.
  3. No theft or destruction of property.
  4. Smoking or vaping only in designated outdoor areas.
  5. Residents must adhere to prohibited substances/items list provided at admission. Any of these items found in a resident’s possession is subject to confiscation without warning.
Property Rules — Acknowledgment

Safety

  1. Bedroom doors may not have keyed locks or deadbolts, as required by NJ regulations.
  2. Report emergencies immediately.
  3. Follow all fire safety procedures.
  4. Do not tamper with smoke detectors or fire equipment.
Safety — Acknowledgment

Meetings

  1. Weekly mandatory house meeting.
  2. Attendance is required unless excused for work or treatment. Excuses must be communicated prior to the house meeting occurring.
Meetings — Acknowledgment

Transportation

  1. Residents must maintain valid driver’s licenses, registration, and insurance if operating a vehicle.
  2. Vehicles must be parked only in designated areas.
  3. Vehicles are subject to search by staff for any reason or randomly.
  4. Residents are required to take provided transportation to treatment services for the first 30 days or while on blackout.
  5. Residents may not transport fellow residents to treatment services.
Transportation — Acknowledgment

Rule Violations – Progressive Interventions

Violations may result in one or more of the following progressive interventions:

  1. Verbal warning.
  2. Written warning.
  3. Behavioral contract.
  4. Increased monitoring or testing.
  5. Discharge from the residence for serious or repeated violations.
  6. Extension of blackout period.
  7. Revocation of privileges in the sober living.
Rule Violations – Progressive Interventions — Acknowledgment

Immediate Discharge Offenses

  1. Use or possession of alcohol or illicit drugs.
  2. Violence or credible threats.
  3. Possession of weapons.
  4. Distribution of drugs or medications.
  5. Theft.
  6. Tampering with drug screens.
Immediate Discharge Offenses — Acknowledgment

Resident Acknowledgment & Signature

I acknowledge that I have received, read, and reviewed the Princeton Sober Living Resident House Rules. By checking each section above, checking the box below, and submitting this form, I confirm that I understand the expectations of residency and agree to comply with these rules. I understand that violations may result in progressive interventions or immediate discharge where indicated.

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.

Resident Acknowledgment
Name
This is to certify that I received a negative result for my urine screen.
Date / Time