Membership Application

* indicates required field

Select a contact:*

First Name:*

Last Name:*

Email:*

Re-enter Email:*

Date of Birth:*

Drivers Licence #:*

State:*

Phone #:*

Emergency Contact:*

Relationship:*

Address:*

Contact Phone #:*

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MEDICAL INFORAMTION

How long have you been sober?*

Drug(s) of Choice:*

Which 12 step meetings do you attend:*

AA
NA
CA

Sponsor Name:*

Sponsor Phone #:*

List medical conditions:*

List prescription medications:

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RESIDENT INFORMATION

Have you ever lived in a Sober Living home?*

Yes
No

If yes, which one?

Are you involved in any legal action?*

Yes
No

If yes please explain:

Are you required to register as a sex offender?*

Yes
No

Have you ever been convicted of arson?*

Yes
No

If yes, was it a felony?

Yes
No

If yes, how many felony counts?

Source of income:*

Salary:

You are paid:

weekly
bi-weekly
monthly

___________________________________________________________________________

Member Dues and $200.00 move-in deposit must be paid on or before the day of arrival.

Requested move in date:*

___________________________________________________________________________

IMPORTANT NOTICE:

Brightside Sober Living is a recovery home which requires expulsion, without prior notice or refund of deposit and fees, of any resident member who is found to be:

using alcohol or drugs
engaging in disruptive behavior;
in default of payment of weekly membership fee. All resident tenants of Brightside Sober Living are members of our recovery home.

You do NOT have renter’s rights or any rights of tenants pursuant to the Texas Property Code, and expressly waive any such rights in exchange for membership privileges. I have read the above notice and understand that I am applying for membership of Brightside Sober Living as a member of a recovery home. I agree to abide by the responsibilities and requirements of the house and fully subject myself to the rules of the home, which include periodic/random drug testing. I understand that I am subject to immediate expulsion from the home if any of the following occur:

I use alcohol or drugs (other than prescribed medications)
I engage in disruptive behavior (continued patterns of irresponsible behavior are considered disruptive behavior)
I fail to pay my weekly membership fee. I understand that if I leave voluntarily and at least 30 days written notice is given to the house manager, my deposit will be refunded after deductions are made for any unpaid fees, damages or fines for which I am responsible. If less than 30 days notice is given or I am expelled from Brightside Sober Living, I understand that my deposit and member fees will be forfeited.

By signing below, I certify that the information contained in this application is true. I have read and understand the Brightside Sober Living house rules and policies. I understand and accept the above conditions set forth for membership to Brightside Sober Living, and agree to abide by said conditions should I be selected as a member resident.

Please check "Agree" for electronic signature*

Agree
Not Agree

Today\'s Date:*

___________________________________________________________________________

Additional information:

MEDICAL INFORAMTION

RESIDENT INFORMATION

Member Dues and $200.00 move-in deposit must be paid on or before the day of arrival.

IMPORTANT NOTICE:

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