God’s Goons Sober Living HomeResident Application Form Name First Name Last Name Date of Birth * MM DD YYYY Phone (###) ### #### Email * Social Security Number (last 4 digits) * Emergency Contact Name First Name Last Name Emergency Contact Phone # (###) ### #### Date of Sobriety MM DD YYYY Have you completed a 28-day treatment program? Yes No If yes, provide facility name and completion date. Are you currently on any form of Medication-Assisted Treatment (MAT)? * MAT is not allowed. If yes, this will disqualify you. Yes No Are you willing to attend 3 recovery meetings weekly and Sunday church service? * Yes No Do you have any pending legal issues or probation/parole requirements? * Yes No If yes, please explain: Current Employer (If applicable) Work Schedule/Shift Are you financially able to commit to weekly rent? * Weekly Rent $150 (Money order only. Due every Friday.) Yes No Are you willing to commit to a 1-year lease and comply with curfews? * Yes No House Rules Agreement * By signing below, I acknowledge and agree to abide by the following conditions: Remain sober and drug-free at all times Submit to random drug testing Not be on MAT (Suboxone, Mathadone, etc.) Attend 3 recovery meetings weekly Attend Sunday church services Adhere to curfew (10 PM; 1 hour after 2nd shift ends) Treat other residents with respect Pay rent on time each week via money order Signature of Applicant: * Date MM DD YYYY Application submitted. A representative will be in touch soon. Thank you for considering God’s Goons Sober Living Home.