Safe Haven
Sober Living

Resident Intake Application
Contact us via email or the contact form to receive a code. Enter the access code provided by our staff to continue with the application.

Access Code
Incorrect access code. Please contact Safe Haven staff for your code.

Code not working? Contact us at
info@safehavensoberliving.org
or call your assigned case manager.

Safe Haven · Resident Application
Step 1 of 5 20%
Step 1 of 5
Personal Information
Please fill out all fields accurately. This information will be kept confidential and used only for program purposes.
📋 All information provided in this application is confidential and protected. Fields marked * are required.
👤
Basic Information
🆘
Emergency Contact
💼
Employment
Step 1 of 5
Step 2 of 5
Health & Recovery
This information helps us provide the best possible support during your stay. All health information is kept strictly confidential.
💊
Health & Medications
⚠️ ALL MEDICATIONS ARE TO BE KEPT SECURED IN A LOCKED SAFE/BOX. Residents are individually responsible for providing their own safe/box.
🌱
Substance History & Recovery
⚖️
Legal Status
Step 2 of 5
Step 3 of 5
Placement & Payment
Tell us about your preferred placement and how your program fees will be covered.
🏠
House Preference & Dates
Final assignment is at the discretion of Safe Haven staff based on availability.
💰
Program Fee & Payment
The program fee is $750.00 per month, payable prior to admission and on the first of each month thereafter. A late fee of $50 per day applies after the due date.
Step 3 of 5
Step 4 of 5
Agreements & Initials
Please read each section carefully and initial where indicated to confirm your understanding and agreement.
📄

Guest Housing Statement

You are not a tenant at Safe Haven, you are a program participant and our guest and as such you may be asked to vacate the premises immediately, at any time, at the discretion of a House Manager or the Safe Haven team, for non-compliance of any house or work rules or other inappropriate behavior. Under these circumstances, the program fee (or any portion thereof) is nonrefundable. Additionally, at such time as deemed appropriate by the Safe Haven Sober Living LLC team, you may be advised that it is time for you to transition out of the program and back into society at which point you will be given no less than 30 days notice. If you decide to transition out at your own discretion, no prior notice is required but you must leave the room and furniture clean and damage free.
I FULLY UNDERSTAND, ACKNOWLEDGE AND AGREE TO ABIDE BY THE GUEST HOUSING STATEMENT IN ITS ENTIRETY.
💵

Program Fee Agreement

FEE is $750.00 monthly. Late Fee is $50 each day it is late to incentivize early and on-time payments. Rooms are rented by the month only. 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/her respective living area, does not return to the premises without permission) he/she is likely to receive a refund of any overpayment. All refunds are given at the discretion of Safe Haven Sober Living. Departing clients must allow at least 14 days for the processing of any refund.
I understand and agree to the fee structure, late fees, and refund policy as stated above.
🚫

Abstinence & Conduct Agreement

The Safe Haven Sober Living program requires complete abstinence from Drugs and/or 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. A client's inability to maintain employment and pay his/her rent in a timely manner can/will result in eviction. By initialing/signing, I acknowledge agreement to the terms stated, and hereby waive my right(s) to normal due process afforded by local landlord-tenant laws.
I agree to maintain complete abstinence from drugs and alcohol and conduct myself respectfully at all times.
📋

House Rules & Guidelines

1. Consumption or possession of beverage alcohol in any form is strictly prohibited. Use or possession of illegal drugs in any form is strictly prohibited.

2. Drug and/or alcohol use will result in immediate removal. The resident agrees to leave the premises immediately and not return for any reason without permission from the House Manager and/or Safe Haven Sober Living.

3. Lying, Cheating & Stealing are strictly prohibited. If caught, you are subject to lose privileges, possible termination and/or eviction.

4. Residents are required to submit to a Drug and Alcohol Screen/Test at LLC owner/house manager request at any time (24/7). Refusal and/or failure to provide an adequate sample will be treated the same as a positive test result.

5. Daily attendance at "12 Step" meetings is strongly encouraged. The minimum daily attendance requirement is 3 per week. Residents are required to maintain a Home Group and a working relationship with a Sponsor.

6. Smoking inside any Safe Haven Sober Living home is strictly prohibited.

7. Overnight guests are strictly prohibited. Guests of the opposite sex are strictly prohibited from entering any Safe Haven Sober Living home.

8. New Resident curfew is 10:00pm every night. All others must be in by 11:00pm Sunday–Thursday and 12:00am Friday–Saturday. Quiet time is 11:00pm to 5:00am.

9. Chores are required to be completed daily. Failure to complete assigned chores can/will result in fine/eviction.

10. All prescribed Medications/controlled substances will be retained and dispensed by the House Manager.

11. House Business Meetings are held weekly and are mandatory for every client.

12. Safe Haven Sober Living is NOT responsible for a resident's personal belongings.
I have read all House Rules & Guidelines above and agree to abide by each one.
🧪

Drug Screen / Test Agreement

I understand that I can be tested for Drugs and/or Alcohol at any time, for any reason, per my agreement with Safe Haven 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 Safe Haven Sober Living program and required to leave the premises immediately. My signature below indicates my understanding and consent.
I understand and consent to drug and alcohol testing at any time without prior notice. I understand that refusal equals a positive result.
📷

Surveillance & Audio Agreement

At Safe Haven, in order to protect ourselves as the owners of the residence as well as the health and status of the residents occupying the home, we have installed 24/7 video surveillance and audio. This will be used if any scuffles or issues arise that need to be looked at after the incident to see who was the instigator and who is at fault for the situation. We only check the video when an issue is brought to us. In order to stay a resident at Safe Haven, it is essential that you agree to these terms for your safety and ours so that we can maintain a positive and safe environment.
By initialing, I agree to be under audio and video surveillance in all common areas of the residence.
📜

Temporary Housing Licensee Agreement

This agreement is NOT a lease. Safe Haven Sober Living LLC provides and pays for Utilities, furnishings, cleaning services and controls all keys to the premises and individual rooms. If I violate any rules of the licensee agreement, I may be considered a criminal trespasser and subject to arrest under State Penal Code, "Criminal Trespass." The monthly fee is $750 per month or $23 per day, payable the 1st–4th of each month. A minimum of 30 days notice is required to vacate and receive a deposit and prorated rent refund. Threats or acts of physical violence against other licensees or management will result in immediate termination of this license and may result in criminal charges being filed.
I have read and understand the Temporary Housing Licensee Agreement in its entirety.
⚠️

Reasons for Immediate Discharge

PROGRAM FEES ARE NON-REFUNDABLE IF YOU ARE ASKED TO LEAVE.

1. Use of alcohol or drugs or a strong suspicion by the House Manager that you have used alcohol or drugs.
2. Refusal to submit to a drug test or breathalyzer test.
3. A negative or abusive attitude or any threat of violence or harassment of others.
4. Missing curfew / excessive lateness.
5. Non-payment or late payment of program fee. Payment will be considered late after the 5th of the month.
6. Failing to complete predetermined chores.
7. Non-compliance of any of the house rules or work rules set forth in this agreement.
I have read and I agree to abide by the House Rules and understand the reasons for immediate discharge set forth in this agreement.
Step 4 of 5
Step 5 of 5
Final Signatures
By signing below, you confirm that all information provided is accurate and complete, and that you agree to all terms and conditions of the Safe Haven Sober Living program. Type your full legal name in each field.
✍️
Final Signatures
Full Program Agreement Signature *
By signing, I confirm that I have read, understand, and agree to all terms, rules, and conditions of the Safe Haven Sober Living program including the Guest Housing Statement, Program Fee Agreement, Abstinence & Conduct Agreement, House Rules & Guidelines, Drug Screen Agreement, Reasons for Immediate Discharge, and the Temporary Housing Licensee Agreement. I agree to transition out of the program and vacate the premises within 30 days of notification by any member of the Safe Haven Sober Living team.
Surveillance & Audio Agreement Signature *
I understand and consent to 24/7 video surveillance and audio recording in all common areas of the Safe Haven Sober Living residence for the safety of all residents and staff.
Personal Guarantee of Payment *
The above named individual personally guarantees payment of all charges for daily/monthly fees. By signing, I agree that I am personally responsible for all fees incurred during my stay at Safe Haven Sober Living LLC.
Step 5 of 5