Sober Living Rules Form
Use this form to record resident details, emergency contacts, and acknowledgment of sober living house rules and expectations.
Resident Information
Resident Full Name
*
First Name
Middle Name
Last Name
Preferred Name / Nickname
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Current Room / Bed Assignment
Move-In Date
*
-
Month
-
Day
Year
Date
Emergency and Support Contacts
Emergency Contact Full Name
*
First Name
Middle Name
Last Name
Relationship to Resident
*
Please Select
Parent
Sibling
Spouse/Partner
Friend
Relative
Guardian
Other
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Sober Support Person or Sponsor Full Name
First Name
Middle Name
Last Name
Sober Support Person or Sponsor Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
House Rules Acknowledgment
Abstinence from alcohol and non-prescribed drugs
*
I agree
I do not agree
No use or possession of contraband substances
*
I agree
I do not agree
Compliance with house curfew
*
I agree
I do not agree
Guest and visitor restrictions
*
I agree
I do not agree
Respect for quiet hours
*
I agree
I do not agree
Shared-space cleanliness
*
I agree
I do not agree
Participation in assigned chores
*
I agree
I do not agree
Respectful behavior toward staff and residents
*
I agree
I do not agree
Participation in meetings or check-ins if required
*
I agree
I do not agree
Agreement to follow house management instructions
*
I agree
I do not agree
Daily Living and Accountability
Chores you can regularly help with
Kitchen cleanup
Bathroom cleaning
Common area tidying
Trash and recycling
Laundry support
Meal prep
Yard work
Other
Meal or cooking responsibility preference
Prefer to cook for myself
Can cook for the house sometimes
Would like a shared meal rotation
Need a simple meal plan
Other
Usual wake-up time
Usual bedtime
House meeting attendance expectation
*
Please Select
Will attend all scheduled meetings
Will attend when available
Need advance notice if schedule changes
Other
How often would you like to check in with staff
Will you report absences or overnight stays in advance?
*
Yes
No
Not sure
Other
Medication and Safety Coordination
Do you have any medication storage or coordination needs?
*
Yes
No
Coordination notes (optional)
Incident Reporting and Final Agreement
Preferred method for reporting concerns
*
Phone
Text
In person
Email
Final acknowledgment
*
Resident signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: