Recovery Housing Policy Acknowledgment Form
Review and acknowledge the policies for your recovery housing program.
Resident Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Housing or Program Name
*
Move-In or Acknowledgment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I understand the house rules and the consequences of not following them.
*
I understand
I need clarification
I understand the program's confidentiality expectations.
*
I understand
I need clarification
I understand the program's substance-use policy.
*
I understand
I need clarification
I understand the visitor and curfew expectations.
*
I understand
I need clarification
Submit Acknowledgment
Should be Empty: