Updated August 28, 2008
Handbook for WADE FREEDOM HOUSE Clients
Mission Statement
W.A.D.E. Freedom House Inc. is dedicated:
· To offering a residential recovery program open to those women of our homeless population and others with a sincere desire to recover from the devastation brought on by drugs and alcohol.
· To creating an environment that promotes the discovery, development and relationship to a loving God or "Higher Power."
· To awakening in each client, the awareness of her responsibility to the community, our planet, and her fellow man.
· To teaching a respect for all people and of all life.
· To bringing out the best in the client.
· To helping the individual receive the training that will provide "meaningful" employment.
· To teach the importance of and allow the individual the chance to help others.
To help in accomplishing these goals we call on the various social service agencies in the area, the different 12-Step programs that address the individual needs of the client, and the churches of the area that recognize that alcoholism is a disease and not a disgrace and that with the help of a loving God the client can achieve the quality of life that we all deserve.
For information:
932 Maple Lane
Jacksonville, Al 36265
256-435-5010 office
Client Initials:_____________ Program Director's Initials:__________
Page Two
WFH HANDBOOK
The primary purpose of the WFH is to provide a clean and sober living environment for women suffering from alcohol and/or drug addiction.
Among the many aspects of early recovery from the disease of addiction, there are two vitally important concepts to which WFH is committed. These are:
1.) The need for the individual to begin to take personal responsibility for her life, and;
2.) The unparalleled therapeutic value of alcoholics and/or addicts working with and supporting each other in recovery.
To provide and maintain a healthy environment with these principles in mind, WFH has four cardinal rules: they are in the order of importance:
1. PARTICIPATION - Morning Meditation and Prayer, Community Projects, Fund Raisers and all house activities.
2. DAILY MEETING ATTENDANCE - The following meetings will meet this requirement: AA (Alcoholics Anonymous), N.A. (Narcotics Anonymous), Church, Freedom House Meeting, Big Book Seminars and other AA/NA related seminars, studies, field trips or workshops.
3. TOTAL ABSTENTION - Residents must abstain from the use of alcohol and all mood-altering drugs (including most prescription medications). Residents may not bring any of these substances onto the premises.
4. HEALTHY EMPLOYMENT - Residents must seek and maintain healthy employment. WFH will strive to make employment available through its various ventures and projects. Such employment will demand punctually and devotion as would any other employment. Lack of enthusiasm and dependability will result in dismissal from both the employment and their WFH residence.
WFH is dedicated to helping its residents incorporate these principles into their lives. The "one on one " of alcoholics and addicts helping each other, and the group help that has been long established as the key to the "12 Step Program of Recovery" can be found here, as well as her participation in her own individual 12 Step Group(s) and program(s).
Client Initials:______________ Program Director's Initials:______________
Page Three
WFH Handbook
FINANCIAL REQUIREMENT
Residents are required to pay a minimum of $17.85 per day.
Additionally, there are drug tests and transportation cost not included. Residents will be assisted, if it is necessary, in establishing a timely and expedient method of payment, to include the INITIAL $250.00 ADMINISTRATIVE FEE THAT IS REQUIRED and non-refundable.
Until a resident is paid up-to-date, she will turn over 75% of her earnings to the House Manager until caught up. Paychecks can be required to be made out to both the client and WFH until such time as these requirements are met.
WFH cannot operate without money; we all suffer when one doesn't pay her part.
RESIDENCY COMMITMENT
For residents, a minimum six month commitment is required; however, in some cases one year to 18 months, and this length of time can be determined by a court, if ordered.
DISMISSAL
* Any person who drinks, uses, or possesses alcohol or any mood altering drugs on her person or on the premises can be automatically dismissed.
The following behaviors can also result in immediate dismissal from the house:
1. Any type of negative remarks or acts of disloyalty to WFH, its staff, or its program(s).
2. Engaging in acts of violence or threats of violence.
3. Theft.
4. Willful destruction of property.
5. Failure to attend daily meetings, the required house meetings, and group or individual counseling when required.
6. Failure to report another resident who is drinking or using.
Client Initials:______________ Program Director's Initials:______________
Page four
WFH Handbook
DISMISSAL (Continued)
7. Refusal to submit to a drug/alcohol test when asked.
8. Other conduct or actions potentially detrimental to WFH, its program or its other residents.
9. Failure to get along with others.
10. Failure to maintain a positive attitude at all times.
11. Failure to do chores willingly.
12. Failure to demonstrate politeness to others or a lack of any of the social skills needed to live in a family setting.
13. Failure to get up and/or stay up.
IT IS THE RESPONSIBILITY OF EVERY RESIDENT TO ENFORCE THIS POLICY
GENERAL HOUSE RULES
MEALS The "house" will not provide any meals. There has so far never been a lack of foodstuffs as a large supply of food is donated for the use of our clients. In addition, most clients are eligible for food stamps that are applied for upon admission. Any food or drink items purchased by a resident for their personal use must be marked clearly with their name before putting in the refrigerator. Marked items in the refrigerator are not to be eaten without the permission of the person the item belongs to.
CHORES All residents will participate in the general maintenance and care of the house and its property.
Chores will be assigned each week and must be completed before going to work. Sleeping areas must be kept neat and all personal items kept in their assigned place. Beds must be made each morning before meditation and prayer. Sheets and towels must be washed weekly.
PERSONAL HYGIENE - All clients must bathe each day. Shirts, pants/skirts, shoes, etc., are to be worn in all public areas.
Client Initials:________________ Program Director's Initials:____________
Page five
WFH Handbook
GENERAL HOUSE RULES (Continued)
VISITORS (for those living at Freedom House)- No visitors are allowed on property or jobs.
TELEPHONE USE - During probation, no phone calls will be made unless the house manager grants permission. However, all phone calls are subject to be taped or otherwise monitored.
SIGNING IN/OUT - Each resident is required to sign out when leaving the house, and sign in upon returning.
RELATIONSHIPS - Any relationship that distracts from the client's recovery is to be avoided at all cost. Distracting relationships will result in dismissal.
MEETINGS - Residents are required to support any meetings held at Freedom House
CHURCH - Residents are required to attend church Sunday morning if not working.
ATTITUDE - Residents must maintain a positive attitude and show a willingness to work with and get along with other house members and WFH clients. Any negativity expressed to any house member on WFH property or anywhere else can result in immediate dismissal.
Client Initials:______________ Program Director's Initials:_____________
Page six
WFH Handbook
GENERAL HOUSE RULES (Continued)
LANGUAGE - Profane, vulgar, slurs, or derogatory language is not permitted anywhere including the general public. Dismissal, extra labor and/or a monetary fine can be levied for each violation.
NEGATIVITY - Any negative comments will be shared only with resident staff, if they will listen, and only then with their permission and out of the hearing of others.
TV AND RADIO - TV and radio is to remain off Monday through Saturday until after 5:00 p.m. (some exceptions apply) and will not be allowed during the "house" supper period. They must be turned off by 9:00pm. News and positive programming and videos that do not contain violence & profanity are the only viewing or listening entertainment permissible. NO LOUD MUSIC EVER ON ANY WFH PROPERTIES!
SECURITY - Lights are to be out in the kitchen and hallways at 9:00 p.m. at which time the doors are locked also. The last person out of the living room will turn out the lights. This will be done no later than 9:00pm.
W.A.D.E. FREEDOM HOUSE
RULES
*)MON.-FRI. MUST BE UP BY 6A.M. MUST BE FULLY DRESSED, BED MADE, AND OUT OF ROOM BY 6:30A.M.
*)SAT. & SUN. UP BY 7A.M.
*)ROOMS MUST BE CLEANED BY 7:30A.M.
*)SHOWERS IN THE MORNING MUST BE COMPLETED BY 7:30
*)MUST BE FULLY DRESSED WHEN COMING OUT OF ROOM
*)BRA IS TO BE WORN AT ALL TIMES
*)NO TANK TOPS OR SHORTS ABOVE YOUR KNEES
*)DO NOT GO INTO ANY OTHER ROOM BUT YOUR OWN
*)DO NOT GO INTO ANY OTHER CABINETS OTHER THAN YOUR OWN
*)NO SLEEPING OR LAYING DOWN UNTIL THE LAST MEETING OF THE DAY AND CHORES ARE COMPLETED
*)NO COOKING FROM 8A.M.-11:50A.M. AND 2P.M.-3:50P.M.
*)NO FRYING FOODS AT ANY TIME
*)NO T.V. FROM 8A.M.-5P.M.
*)DO NOT WALK TO MAIL BOX
*)DO NOT LEAVE DIRTY DISHES ANYWHERE
*)CLEAN UP BEHIND YOURSELF AT ALL TIMES
*)NO DRINKS OR CUPS IN THE REFRIGERATOR (NO OPEN BOTTLED DRINKS)
*)ONLY SMOKE IN DESIGNATED SMOKING AREA
*)SMOKING IS ALLOWED 10 MIN. TO EACH HOUR
*)DO LAUNDRY ON DESIGNATED DAY
*)TALKING IS NOT ALLOWED DURING BOOKWORK
*)BOOKWORK IS 10A.M.-12 FREETIME 12-2P.M. BOOKWORK RESUMES AT 2P.M.-4P.M. (3P.M. ON FRIDAYS)
*)NO WRITING LETTERS DURING BOOKWORK
Page seven
*)ALL A.A. AND N.A. BOOKS ARE TO REMAIN IN MEETING ROOM FOR EVERYONE TO USE
*)NO CROSSTALKING DURING MEETINGS
*)NO EATING DURING MEETINGS
*)YOU MUST PARTICIPATE IN ALL MEETINGS
*)MORNING MEDITATION IS AT 7:30A.M.
*)NO BOOKS THAT ARE NOT RECOVERY RELATED
*)YOU MAY HAVE 10 SHIRTS, 10 PAIR OF PANTS, 4 PAIR OF SHOES, 10 BRAS, 10 PAIR OF PANTIES, AND 2 PAIR OF P.J.'S IN YOUR ROOM
*)NO PLAYING CARDS
*)NO ARGUING ABOUT CHORES
*)NO FORNICATING
*)NO FOOD OR DRINK ALLOWED IN ROOMS
*)MED. CALL IS ONCE DAILY AT 8P.M.
*)DO NOT CHEAT ON BOOKWORK (NO COPYING STRAIGHT FROM BOOK)
*)EVERYONE IN ROOMS BY 9P.M. LIGHTS OUT BY 9:30 SUN.-THURS. IN ROOMS BY 10P.M. AND LIGHTS OUT BY
10:30 FRI. AND SAT.
*) DO NOT LEAVE LIGHTS OR FANS ON IN ROOMS
*)SAT. 8A.M.-12 CLEAN HOUSE AND MOW GRASS BREAK FROM 12-12:30P.M. 12:30-3P.M. HOUSEWORK AND YARDWORK
*)NO PHONE CALLS FOR THE FIRST 2 WEEKS
*)NO MAIL FROM JAIL OR PRISON IS ALLOWED UNLESS APPROVED BY DEBBIE
*)ALL PACKAGES MUST BE PRE-APPROVED BY DEBBIE
*)MUST HAVE DAILY GREATFUL LIST (LIST OF 10)
*)MUST WRITE IN JOURNAL DAILY
*)ALL MAIL IS READ (INCOMING AND OUTGOING)
*)DO NOT TALK TO REPAIR MEN, PHONE MAN, OR ANYONE WHO IS NOTA RESIDENT OR COUNCELOR
*)NO STEALING
*)NO VISITORS AT HOUSE, JOB, OR CHURCH
*)NO PHONE CALLS AT WORK
*)GROCERY STORE ONCE A WEEK AND WAL-MART ONCE A MONTH (3RD WEEKEND OF THE MONTH)
*)YOU ARE RESPONSIBLE FOR WRITING DOWN YOUR TRIP CHARGES (IF YOU FAIL TO DO SO, YOU WILL BE CHARGED THE MAX. AMOUNT)
*)NO PASSES UNLESS YOU ARE COMPLETELY PAID UP
*)YOU WILL BE DRUG TESTED UPON RETURNING FROM PASS
*)NO ENERGY OR VITAMIN BEVERAGES
*)NO ENERGY SUPLIMENTS
*)ALL MEDICATIONS MUST BE APPROVED (EVEN OVER THE COUNTER)
*)NO CANNED OR 2 LITER DRINKS (BUY DRINKS FROM VENDING MACHINE DOWNSTAIRS)
Page eight
*)NO DISRESPECTING OTHERS
*)NO NEGATIVITY
*)DO NOT ERASE DRY ERASE OR CHALK BOARDS
*)IF YOU ARE SUSPECTED OF BEING HIGH, YOU WILL BE DRUG TESTED AT YOUR OWN EXPENCE
*)IF YOU HAVE A POSITIVE DRUG SCREEN YOU WILL BE RESPONSIBLE FOR THE $50 TO SEND IT TO THE LAB
*)POSITIVE SCREEN FROM LAB WILL RESULT IN YOUR DISMISSAL
*)DO NOT TOUCH AIR CONDITIONER CONTROL PANEL
*)DO NOT SMOKE IN HOUSE CARS
*)DO NOT THROW CIGARETTE BUTTS IN THE YARD
*)DO NOT FLUSH TAMPONS OR PADS. PUT THEM IN TRASH CANS
*)KITCHEN CLOSES AT 8P.M.
*)DO NOT THROW FOOD IN TRASH CANS. IT IS TO BE PUT IN THE PIG BUCKET OUTSIDE THE DOOR
*)ALL TRASH GOES IN DESIGNATED CAN (NON-BURNABLE, BURNABLE, AND ALUMINUM CANS) FAILURE TO ABIDE BY THIS WILL RESULT IN SORTING THE TRASH
*)NO BATHS-SHOWERS ONLY. LIMIT TIME IN BATHROOM TO 10 MIN. IN DESIGNATED BATHROOM
*)CLEAN UP AFTER YOURSELF AFTER YOUR SHOWER
*)DO NOT UNPLUG BLACK COFFEE POT
*)PHONE CALLS LIMITED TO 10MIN.
*)WRITE YOUR NAME ON ALL OF YOUR PERSONAL ITEMS IN THE KITCHEN AND BATHROOM
*)DO NOT TAKE ANYTHING THAT DOES NOT BELONG TO YOU
*)IF YOU ARE DISCHARGED YOU HAVE 72 HOURS TO PICK UP YOUR PERSONAL ITEMS
*)WHEN YOU LEAVE ON PASS YOU MUST LEAVE WITH IMMEDIATE FAMILY ONLY AND YOUR FAMILY MUST REMAIN IN THEIR VEHICLE
*)PASSES- 24 HOUR PASS IS FROM 12A.M. SAT. TO 6P.M. SUN. ON THE 1ST WEEKEND OF THE MONTH
DAY PASS IS 9A.M.-6P.M. ON SUN. ON THE 3RD WEEKEND OF THE MONTH
*)DO NOT LEAVE YOU JOB. YOU WILL BE PICKED UP IN 2 HR. INTERVALS
*)DO NOT BE DISRUPTFUL AT CHURCH
*)NO MOUTHWASH CONTAINING ALCOHOL
*)NO LISTENING TO MUSIC DURING BOOKWORK
*)ROOMS MUST BE CLEAN AND ORDERLY AT ALL TIMES
*)ONLY 1 STUFFED ANIMAL, 2 PILLOWS, AND BLANKET ON BED
*)NO CELL PHONES
*)NO DESTRUCTION OF ANY PROPERTY
*)NO VIOLENT BEHAVIOR
*)ALL BOOKWORK IS TO BE TURNED IN ON TIME
*)NO WATCHING T.V. OR HANGING OUT DOWNSTAIRS
Page nine
*)NO ROAMING AROUNG HOUSE AFTER LIGHTS OUT
*)NO THROWING TRASH OUT OF VEHICLES
*)NO THROWING TRASH IN YARD
FAILURE TO COMPLY TO THESE RULES COULD RESULT IN A WRITE UP, RESTRICTIONS, COMMUNITY SERVICE, OR DISMISSAL
Client Initials:______________ Program Director's Initials:_____________
Page ten
WFH Handbook
CHURCH ATTENDANCE POLICY
When we arrive at WFH, we profess that we are "ready to go to any length" to turn our life around and begin a life of sobriety. We agree also to change our "playgrounds" and "playmates."
Often we are physically depleted and run down. Within just a few weeks of arrival here, with better eating and regular sleep habits, this is usually corrected.
Generally, we are also emotionally depleted as well. Sometimes outside help must be sought before complete healing can take place. Often however, this is corrected as we pursue the "Steps" that are spiritually demanded by our 12 Step program.
Most important of all however, we are all spiritually bankrupt. The Twelve Step program(s) we have committed ourselves to is a spiritual program. Without spirituality and the development of a relationship to a "Higher Power" we are doomed for failure, and unless we change - nothing in our lives will change.
WFH encourages and requires that you go to a church attended by other "12 Step" people from outside the house.
When possible, we will try to all go as a family to church unless permitted by staff to do otherwise.
I accept and will abide by WFH’s church attendance policy.
Client signature ____________________________________Date_______________________
Page eleven
WFH Handbook
PROBATION PHASE *
For the clients of our program:
The probation phase consists of fourteen days, unless extended by staff for lack of completion or compliance of the following:
1) Apply promptly for food stamps if you are eligible.
2) Obtain your Social Security card and picture ID if you don’t already have.
3) Attend all meetings.
4) Perform your house chores willingly. They must be completed by the time designated by the house staff.
5) No phone calls, unless approved by house manager.
6) Journal daily.
7) You may leave the "house" only for work, food stamps, meetings and church. Another member of the house must accompany you unless staff grants permission.
8) You must show a willingness to work with and get along well with other house members.
9) You must start applying for employment.
10) You must complete Step One complete with life story and powerless list.
11) Complete reading the material in the "Big Book" from the “Preface” through page 71.
12) Make a gratitude list of 10 items and demonstrate how you are showing your gratefulness for them.
13) Always sign out when leaving and sign in upon returning.
14) Obtain your own AA Big Book and "12 step packet."
An interview will be conducted at the end of fourteen days to determine whether you have demonstrated the social skills, the willingness, the honesty, the ability to get along well with others, and an attitude that promotes harmony. This interview will determine if you will be allowed to continue your residency at "Freedom House."
You may also decide that what we have is not for you. If we both agree that Freedom House is where you belong, then at this time, the "Commitment to Continue" form will be signed.
*Note: Those coming to us from the jail or prisons often are not allowed to "decide that what we have is not for you" without terminating their furlough.
Completed Probation this _______ day of ________________, 200___.
_______Accepted ________Rejected
Program Director's Signature: ______________________________
Client Initials: _____________ Program Director's Initials: ______________
Page twelve
WFH Handbook
Acknowledgment and Commitment
I hereby acknowledge that I have read and initialed each of the preceding pages and understand the WFH Handbook and its rules and the reason for them. I commit myself to total participation and devotion to its purpose for a minimum of 6 months. I realize that staff can extend this if sufficient progress including attitude is not being achieved.
If I am on furlough from jail or prison, I am aware that my attorney, probation officer or anyone other than the court and/or WFH cannot cancel this commitment. I will report to the court or other appropriate authority anyone who encourages me to not complete this commitment.
I acknowledge the $____________________per day financial commitment I have made toward the expenses for the operation of WFH’s recovery program. I realize that this is approximate and the actual amount will be based upon how quickly I move from phase to phase. Until the financial agreement is up-to-date, WFH will take 75% of my pay during such time to be applied toward my account.
I FURTHER UNDERSTAND THAT FAILURE TO PAY MY FEES AND MOVING OUT WITHOUT THE FULL PAYMENT OF ALL EXPENSES MAY CONSTITUTE "OBTAINING LODGING BY FRAUD" AND CRIMINAL CHARGES CAN BE FILED AGAINST ME.
Payments are to be made on the day I am paid unless other arrangements are made.
I further acknowledge the house manager has carefully gone over and explained each page of this document.
I further understand that it supersedes any previous agreements I may have had either verbally or written.
_________________________________ Date ________________ Client/Resident
Accepted: ________________________________ Date ____________________
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WFH Handbook
HANDBOOK ADDENDUM
(GIVE THIS PAGE AND NEXT TO CLIENT)
SCHEDULE & POLICY FOR RESIDENTS
Mornings
6:00 - Wake up - Make beds - Clean area – Get dressed - All areas cleaned and beds made
7:30 -Morning Meditation
8:00-10:00 house work
10:00-12:00 book study
12:00-2:00 free time (lunch, shower, exercise) no laying down or TV
2:00-4:00 book study
4:00-6:00 dinner time
6:30 meeting
8:00 daily wrap up
9:00 bed time
9:30pm lights out
Sunday
0700 - Wake up - Make beds - Clean area 0800 - All areas cleaned and beds made 0930- * Church
House Conduct
*) T.V. is to be turned off by 9pm.
*) T.V. and radio is to remain off at House Monday thru Friday from 9:00 a.m. till 5:00 pm
*) If you are scheduled for washing dishes you must be here unless you have made other arrangements with someone else to cover for you.
*) Residents of Freedom House are required to support any speaker or dinner meeting held at their residence. Working is the only excused absence.
*) Items labeled in the refrigerator are not to be eaten without the permission of the person the item belongs to.
All items are to be marked with the owners' name if the item is not for sharing.
*) Negative talk and blame will not be tolerated. See above as to punishment.
*) Absolutely NO PHYSICAL OR VERBAL ABUSE will be tolerated.
Signed__________________________________Date____________________
Page fourteen
House Conduct continued:
*) Residents are expected to support the activities of WFH, be it Christmas caroling, fundraising activities, or any other WFH effort.
*) Residents will participate in the chores necessary to keep their "house" looking its best at all times.
I HAVE READ AND UNDERSTAND THE ABOVE AND AGREE TO DO MY PART.
________________________
NAME
Page fifteen
CLIENT SELF EVALUATION:
(Based on your present level of understanding)
Client _______________________________ Date ___________________
Time in your 12 step "program" this time _____________ Previous time in the "program"
Presently working "step" number ___________
Your understanding of the "program" good ____ fair ____ poor ____
Rate yourself on each item below on a scale from 0 – 3
3 - Good
2 - Fair, needs to work on
1 - Unsatisfactory, present conduct unacceptable
0 - Fails to comply
1) Maintains positive attitude _________
2) Deals well with anger _____________
3) Deals well with resentment ________
4) "Open" to change ________________
5) Honest with himself ______________
6) Attends meetings daily ___________
7) Daily contact with sponsor ________
8) Maintains sobriety _______________
9) Works well with others __________
10) Conservative of utilities __________
11) Does house chores willingly ______
12) Honest with others _____________
13) Works the "steps" _____________
14) Control issues -"live & let live" ______
15) Takes suggestions of his sponsor and staff ______
16) Considerate of the feelings of others __________
17) Takes responsibly for the property of others when borrowing _______
18) Respects the property of others _____
19) Respects the "house" property ______
20) Participates in house functions ______
21) Keeps his area neat and clean _______
22) Gives of himself without expectation of reward ______
23) Friendly and courteous to those he works with and the general public ______
My Meeting Schedule
Client Name __________________________
___Date___|__Time__|___Name_of_Group___|____Chair_Person____|____________Topic___________
__________|________|___________________|____________________|____________________________
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Notes:
List any changes or additions agreed upon between staff and client. To be signed by both parties.
Discharge Authorization
I hereby release any and all paychecks owed to me to W.A.D.E. Freedom House Inc. And furthermore release and authorize WFH to apply my paycheck to any balance owed to WFH. I hereby authorize WFH to collect and deposit any outstanding paychecks and apply towards my balance.
By signing this release I understand any outstanding paychecks will be deposited on my behalf on any outstanding balance owed to WADE Freedom House Inc. If there is not a balance owed WFH will not pick up any check owed to you.
I understand and fully agree with this policy.
_________________________resident
__________________________date
___________________________witness
W.A.D.E. Freedom House Inc.
932 Maple Lane
Jacksonville, Al 36265
256-435-5010
LIABILITY RELEASE FORM
On this ______day of _________,200__, intending to be legally bound hereby, the undersigned agrees and does hereby release from liability and to indemnify and hold W.A.D.E. Freedom House Inc. and any of its employees or agents representing or related to the W.A.D.E Freedom House Inc. This release is for any and all liability for personal injuries (including death) and property losses or damage occasioned by, or in connection with any activity or accommodations for this event. The undersigned further agrees to abide by all the rules and regulations promulgated by W.A.D.E. Freedom House Inc. and/or its affiliate groups and venders throughout the W.A.D.E. Freedom House Inc.
___________________________residents name.
___________________________signature of resident.
___________________________W.A.D.E. Freedom House Inc. employee
Drug Test Agreement Form
This agreement must be signed and dated before admission.
This agreement is between W.A.D.E. Freedom House Inc. and Resident.
I _______________________ agree to submit to random drug screens upon request. I am also aware that I will be charged $20.00 for every screen I am requested to take. I am aware that the test will be UA (urine analysis).
I also understand that I have a right to question the result of the UA and may request GCMS. If I choose to have GCMS I understand that the cost of test are $50.00. Both fees are non-refundable.
As a resident of W.A.D.E Freedom House Inc., I will be required to take a UA test at any time the director, Deborah Petree , or any other employee at W.A.D.E Freedom House Inc., feels it is necessary. I also understand that no test will be administered without the full consent of Deborah Petree.
I also understand that a positive result could be punished by, permanent restriction, notifying of proper authorities and or probation officer, and or eviction.
I am also aware that if I am evicted I will not be permitted to submit an application with W.A.D.E. Freedom House Inc. for six months. I am also aware I can only be accepted two times by this organization.
I, _______________________have carefully read, and understand this agreement.
I, _______________________a W.A.D.E representative witness the signature of the above.
This agreement was placed in affect on the date of ___________________.
W.A.D.E. FREEDOM HOUSE INC.
A NONPROFIT CORPORATION
SOBER LIVING FOR WOMEN
932 MAPLE LANE
JACKSONVILLE, AL 36265
www.wadefreedomhouse.com
APPLICATION PACKET
RESIDENTIAL
Please read through the entire material, fill out all forms as indicated and return to:
W.A.D.E. FREEDOM HOUSE INC.
932 MAPLE LANE
JACKSONVILLE AL. 36265
ADMINISTRATIVE OFFICE
INTAKE:
PLEASE CONTACT
Deborah Musselman
@ 256-435-5010
EMAIL: wadefreedomhouse@aol.com
Application packet 3/05
W.A.D.E FREEDOM HOUSE
APPLICATION PROCESS - RESIDENTIAL
APPLICANT: Please read this page for instructions about applying to the W.A.D.E. FREEDOM HOUSE Residential Program. Keep this page for future reference.
I. HOW TO APPLY
1. Fill out the application. Return it and all other forms, as indicated.
2. Read the Community Agreements and the Orientation Policy.
3. Mail, fax or drop your application of (see front for address and phone numbers)
4. You will need to have a drug assessment (done within the past 90 days) before admission.
5. You will need your admission fee of $250.00 upon being admitted into the program.
II. PROCESS
1. When W.A.D.E. FREEDOM HOUSE receives your application an interview appointment will be scheduled with you: this can be done in person or over the phone.
2. Following the interview and collection of all necessary information, the application will then be evaluated by the treatment team to determine appropriate level of care.
3. Bed availability: you should check in once a week, if WADE FREEDOM HOUSE has not heard from you in two weeks, your application will be removed from the application list.
4. Applicants that are incarcerated need to communicate at least monthly to keep us up to date with your needs.
III. MEDICATIONS
If you are taking prescription meds, at least one month’s supply is required upon admission. All medication must have pharmacy all OTC meds out of original container will be disposed of.
***PROGRAM FEES E FREEDOM HOUSE requires that you have at least the $250.00 admission fee and first month’s program fees at time of admission. Program fees are $500 per month.
W.A.D.E FREEDOM HOUSE
CONFIDENTIALITY OF RECORDS
ALCOHOL AND DRUG ABUSE CLIENTS
The confidentiality of alcohol and drug abuse client records maintained by this program is protected by federal and state laws and regulations (Federal confidentiality rule 42CFR Part 2) which prohibits disclosure of information unless expressly permitted by written consent of the person to whom it pertains or as otherwise permitted by 42CFR Part2. A general authorization for the purpose of release of medical or other information is not sufficient for this purpose. The federal rule restricts any use of the information to criminal investigation or to prosecute any alcohol or drug abuse client.
In general, the program may not share client information outside the W.A.D.E. FREEDOM HOUSE program except in the event of:
1. The client consents to specific disclosure in writing.
2. There is receipt of a subpoena and court order, disclosure allowed by court.
3. Disclosure is made to emergency healthcare providers, qualified personnel research, audit or program evaluation.
4. Violation of the Federal and State laws and regulations is a crime and any suspected violations will be reported to appropriate authorities in accordance with federal regulations.
5. Federal law and regulations do not protect information about suspected child abuse or neglect from being reported.
6. Federal laws and regulations do not protest information about a crime committed by a client either at W.A.D.E. FREEDOM HOUSE or against any person who works for the program itself or about threats to commit such a crime.
7. All threats to harm self or others, or crimes against children must be reported.
Client signature: ___________________________________
W.A.D.E. FREEDOM HOUSE INC.
ADMISSION REQUIREMENTS - RESIDENTIAL PROGRAM
APPLICANT: Please use the following as a checklist of eligibility for our program.
FILL OUT AND RETURN TO W.A.D.E. FREEDOM HOUSE
--------- AGE 18 OR OLDER
--------- PRESENTLY FREE FROM ALCOHOL AND ALL NON-PRESCRIBED MOOD-ALTERING OR ADDICTIVE SUBSTANCES FOR A MINIMUM OF TWO WEEK
--------- MEDICALLY STABLE AND ABLE TO COMPLY WITH OUR REQUIREMENTS
--------- VOLUNTARILY SEEKING SERVICES WITH EXPRESSED DESIRE FOR SERVICE.
-------- ABLE TO COMPLY WITH HOUSE REQUIREMENTS AND MANAGE DAILY LIVING (EXAMPLE: DRESS SELF, GROOMING, WORK, ETC)
-------- MENTAL \ EMOTIONAL STATE IS SUFFICIENTLY STABLE FOR PARTICIPATION A HALFWAY HOUSE SETTING.
-------- MEETS CRITERIA FOR DIAGNOSIS OF SUBSTANCE ABUSE OR DEPENDENCE
--------- IS UNABLE TO MAINTAIN ABSTINENCE IN A LESS RESTRICTED ENVIRONMENT
PRIORITY ADMISSION IS GIVEN TO WOMEN WHO ARE PREGNANT
IN ADDITION TO THE ABOVE CRITERIA, THE APPLICANT MUST AGREE TO THE FOLLOWING:
RANDOM DRUG SCREENS
AGREE TO COMPLY WITH COMMUNITY AGREEMENTS
MAKE AT LEAST A SIX MONTH COMMITMENT TO W.A.D.E. FREEDOM HOUSE
FINANCIAL RESPONSIBILITY
RESPECT THE CONFIDENTIALITY OF ALL OTHER RESIDENTS AT W.A.D.E. FREEDOM HOUSE.
CLIENT SIGNATURE____________________________________________
W.A.D.E. FREEDOM HOUSE
APPLICATION FOR RESIDENCY
Please fill out and return to W.A.D.E.
We do not discriminate on the basis of age, race, creed, ethnicity, religion, marital status, or sexual orientation.
Date of application_______________
NAME________________________ DATE OF BIRTH__________________
ADDRESS______________________________________________
CITY______________________ COUNTY ______________ STATE ______ ZIP.________
PHONE ( )_____-__________ SOCIAL SECURITY #_______-____-_________
WHY DO YOU WANT TO LIVE AT W.A.D.E. FREEDOM HOUSE?
DRUG(S) OF CHOICE FIRST USE LAST USE HOW DID YOU BEGIN USING
1_____________________________________________________________________________
2_____________________________________________________________________________
3_____________________________________________________________________________
4_____________________________________________________________________________
5_____________________________________________________________________________
HAVE YOU EVER USED NEEDLES?
IF SO EXPLAIN:_______________________________________________________________
______________________________________________________________________________
OTHER ADDICTIVE BEHAVIORS CIRCLE ALL THAT APPLY: FOOD WEIGHT
SEX GAMBLING WORK SHOPPING OTHER:
CURRENT LEGAL STATUS:____________________________________________________________________
LAST OFFENSE:______________________________________________________________________________
PENDING CHARGES:__________________________________________________________________________
COURT DATES:______________________________________________________________________________
PROBATION OFFICER: ____________________________ COUNTY:__________________________________
FINANCIAL STATUS:_________________________________________________________________________
EMPLOYMENT:______________________________________________________________________________
OTHER INCOME:_____________________________________________________________________________
DO YOU HAVE MEDICAL INSURANCE?_________ MEDICAID? ______ MEDICARE?____________
Do you have any medical conditions or disabilities?___________________________________________________
MEDICAL\ PHYSICAL STATUS:_________________________________________________________________
CURRENT MEDICAL PROBLEMS OR NEEDS:____________________________________________________
ALLERGIES:_________________________________________________________________________________
MEDICATIONS, AND WHAT IT IS FOR:__________________________________________________________
PRIOR TREATMENTS (LIST ALL SUBSTANCE ABUSE TREATMENTS AND DATES)__________________
_____________________________________________________________________________________________
LIST ANY OTHER MENTAL HEALTH TREATMENT OR COUNSELING (INCLUDE WHERE AND DATES)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
DESCRIBE YOUR EXPERIENCE WITH 12-STEP PROGRAMS:
DO YOU GO TO MEETINGS NOW? WHY?
IF YES HOW MANY A WEEK?
DO YOU HAVE A SPONSOR? WHY?
DO YOU HAVE A VALID DRIVER’S LICENSE? DO YOU OWN A VEHICLE?
DO YOU PLAN TO HAVE THE VEHICLE HERE?
CAN YOU PROVIDE PROOF OF INSURANCE? MAKE AND YEAR?
WHO SUPPORTS YOU IN YOUR RECOVERY EFFORTS? RELATIONSHIP TO YOU?
DO YOU HAVE ANY OTHER PROBLEMS OR CONCERNS IN YOUR LIFE RIGHT NOW? (DESCRIBE)
DEPENDANT CHILDREN:
NAME AGE WHERE ARE THEY LIVING?
1.
2.
3.
4.
5.
I have completed this application honestly and to the best of my ability. I understand that if I am admitted to W.A.D.E. FREEDOM HOUSE, I need one month’s supply of any prescription medications that I am taking, as well as a pharmacy label on each prescription container. NO NARCOTICS WILL BE ALLOWED.
I have read the community agreements and understand them.
Applicant Signature_____________________________________________
mail, fax or deliver completed application
W.A.D.E. FREEDOM HOUSE
932 MAPLE LANE. JACKSONVILLE AL. 36265
W.A.D.E. FREEDOM HOUSE
COMMUNITY AGREEMENTS
WE DO NOT DISCRIMINATE ON THE BASIS OF AGE, RACE, HANDICAP, CREED, ETHNICITY, NATIONAL ORIGIN, RELIGION OR SEXUAL ORIENTATION.
RULES AND REGULATIONS
IMMEDIATE DISCHARGE
* BEING UNDER THE INFLUENCE OF ALCOHOL AND\OR DRUGS
*POSSESSION OF ALCOHOL AND\OR DRUGS.
*POSSESSION OF WEAPONS
*THREATS EITHER VERBAL OR PHYSICAL, OR ACTS OF VIOLENCE, FIGHTING
*PROPERTY DESTRUCTION OR ALTERING THE PHYSICAL CONSTRUCTION OF THE PREMISES, INCLUDING INTERIOR WALLS
*FAILURE TO SUBMIT A U\A (WHICH ARE ALWAYS AT YOUR COST)
*UNACCOUNTABLE OR DISCREPANCIES IN TIME OFF OF PREMISES
*FAILURE TO COMPLY WITH RULES AND\OR STAFF DIRECTIONS
NO EXCEPTIONS! NO EXCUSES_________________________________
APPLICANT SIGNATURE
COMMUNITY AGREEMENT
1. You are required to attend at least 3 12-step meetings per week, have a program book,(big book, NA text ,etc) and have your meeting slip signed by a member of the group, not another resident, and attend on- premises “ House Meetings” which are held 2 times per week 1-2 hours per meeting.
2. House meeting attendance is mandatory, which means you must arrange for employment that does not interfere with these meetings, there are no exceptions to this rule.
3. For the first 30 days you are to remain on the premises, with the exception to work, during this time you are expected to be working on your steps, and must arrange 12-step meeting attendance with another resident who is not on restriction, or with the house manager, and this must be pre-approved by the house manager.
4. You are required to sign-out when leaving the premises, and sign-in upon return - all leaves must be pre- approved by the house manager.
5. Program fees must be paid every Friday directly to the house manager, and kept up to date without exception.
6. You must see the house manager at least 1 time per week to discuss your recovery program- it does not count as a visit to discuss program while paying rent, unless the house manager chooses to do so.
7. You must obtain a home group and a sponsor (you must provide a contact name and phone number), within the first two weeks of residency, and this will be verified.
8. You must have steps 1, 2, and 3 in writing, and present these in the house meeting by the third week, along with a copy to the house manager.
9. You are required to be employed full time, you are not permitted to quit a job without first discussing it with the house manager, employment status will be checked on periodically.
10. There are certain types of employment that are not allowed, and you must speak with the house manager prior to accepting employment with anyplace.
11. No cab driving, working in bars, clubs or places that sell alcohol.
12. Your room must be kept neat, with your bed made at all times, rugs vacuumed, bathroom cleaned, kitchen area clean, which means absolutely no glasses, dishes, forks, knives, spoons, etc. left in the sink at any time, and any trash disposed of in a timely manner.
13. You will be assigned daily and weekend chores (these are mandatory as part of your stay).
14. All vehicles will have current tags and insurance, this must be verifiable. Also, there will be no storage of vehicles and no working on vehicles on the premises.
15. Any situation that requires police involvement must be discussed with the house manager before the police are called, (any police involvement without house manager approval will be grounds for discharge).
16. There are absolutely no visitors allowed on premises.
17. There will be no congregating in the front of the house, no loud music or discussions, no walkmans, caps, sunglasses bandanas, or inappropriate dress, and you are required to attend to daily hygiene needs.
18. No one is allowed in another resident’s room- period.
19. There are no sharing of clothes, personal property, loaning money, borrowing vehicles either by staff or residents.
20. You may be requested to submit a U\A at any time, which may include either with cause or without.
Also, another resident may request someone to be tested if a persons behavior warrants it.
21. Any resident who is aware of a rules infraction and does not notify the house manager immediately will be subject to discharge, which includes finding out later that you knew about it.
22. All rooms are subject to inspections at any given time and any room that does not pass inspection may cause all residents in that room to be discharged.
23. Smoking is permitted outside in designated smoking areas only. Do not throw cigarette butts anywhere on property, use the proper receptacles.
24. Phone hours are from 8:00 am until 9:00 pm. All calls are to be pre approved by the house manager.
25. Any cooking done by residents require immediate clean up.
26. Any delegation, directive, or request that is made by staff will then become rule.
27. Any medical conditions and\or injuries must be brought to the attention of the house manager.
28. Calls to 911 for medical conditions, injures, etc. must be approved by the house manager.
29. If there is an emergency, call 911, and then notify the house manger immediately.(COMMON SENSE)
30. Any medication Rx or OTC will be kept and locked up by the house manager and dispensed accordingly to instructions on the bottle. Any failure to surrender any and all medication will cause you to be discharged.
31. House shutdowns will occur if house chores are not done, the grounds and buildings not cared for, rooms are not kept clean, or general attitudes are not in line with house etiquette, and is done so at the discretion of the house manager.
32. All rules and regulations are subject to additions and changes at the house managers’ discretion.
33. Wake up time is at 6:00 am. You are to be showered and fully dressed before 6:30 am. Bedtime is 9:00 pm. Sunday thru Thursday and 10:00pm Friday and Saturday wake up times for Saturday and Sunday is 7:00 am.
34. AS A RESIDENT I AM AWARE OF THE PRIVACY LAW THAT PROHIBITS ME FROM DISCUSSING HOUSE ISSUES OR OTHER CLIENTS, WHILE I AM OUTSIDE OF THE HOUSE. JUST LIKE AN A.A./N.A. MEETING, WHAT HAPPENS HERE OR WHAT IS SAID HERE STAYS HERE.
35. Any and all fees paid to the house are non-refundable. Refunds will not be given on any payments if resident is terminated under any circumstance, voluntary or otherwise.
This is not a complete list of all possible rules and\or violations that may happen, so to insure a healthy, happy, drug and alcohol free recovery environment please do your part to use common sense when it comes to either doing or not doing something that may affect yours and others continued stay.
Finally, staff will not take the role of cop, lawyer, or investigator. This means discharges will occur without investigation of who did what, what was said, who is, or who is not at fault.
I have read and understand the rules and regulations and by signing below agree to follow all of these rules during my stay at THE W.A.D.E. FREEDOM HOUSE INC.
APPLICANT SIGNATURE___________________________
BELONGINGS YOU SHOULD BRING
NO MORE THAN…….
CLOTHES
10- SKIRTS OR PANTS 2- PAJAMA TOPS
10- SHIRTS 2-PAJAMA BOTTOMS
4-PAIR OF SHOES 2- PURSES
2- COATS 10- PAIR SOCKS 10-PAIR OF UNDERWEAR 10-BRAS
MAKE-UP, HAIR NEEDS, AND PERFUMES YOU MAY BRING
1- BASE 1`- PRESSED POWDER
1 - EYESHADOW 1- EYELINER
1- MASCARA 1- BLUSH
1-LIPSTICK 1-HAIRSPRAY
1-GEL 1- SHAMPOO
1-CONDITIONER 1-BODYWASH
1-SOAP OR ONE PACKAGE, NO MORE THAN 4 BARS.
1-BOTTLE OF PERFUME (SPRAY ONLY)
1-BODYSPRAY
1-HAIR BRUSH
1-CURLING IRON
1-BLOWDRYER
CLOTHES DETERGENT
1-BOTTLE OF LIQUID DETERGENT (MUST BE LIQUID)
1 Fabric softener 1 bleach
HYGIENE PRODUCTS
2-PACKAGES OF PADS 1 package of toilet paper
(TAMPONS ARE DISCOURAGED BECAUSE THEY CAN NOT BE FLUSHED HERE)
1-TOOTHBRUSH 1-TUBE OF TOOTHPASTE
1-BOTTLE OF MOUTHWASH (CAN NOT CONTAIN ALCOHOL)
1 personal cd \ radio w\headphones
Only recovery related materials NA, AA books, Bible, meditation books and Self help, no word books, magazines or novels allowed.
Paper and pens envelopes and stamps
Groceries and snacks, change for drink and snack machine, envelopes and stamps
Change for the drink machine
Envelopes & stamps
