Civara Recovery

Section 1: Resident Information

Welcome to Civara Recovery. We are committed to providing a safe, structured, and supportive sober living environment that promotes accountability, personal growth, and long-term recovery. This packet outlines your rights, responsibilities, house expectations, and required acknowledgments. Please read each section carefully. Your signature indicates understanding and agreement.

Full Legal Name

Preferred Name

Date of Birth

Age

Phone Number

Email Address

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Referral Source (Court, Treatment, Self, Other)

Section 2: Admission Criteria Acknowledgment

By initialing each bullet below, the resident acknowledges:

Resident Initials Civara Recovery is a peer-supported sober living home, not a licensed treatment facility

Resident Initials Participation is voluntary and contingent upon compliance with house rules

Resident Initials Continued residency is based on sobriety, accountability, and respectful conduct

Section 3: Resident Rights

Residents have the right to:

• Be treated with dignity, respect, and fairness

• Live in an environment free from abuse, neglect, and discrimination

• Privacy and confidentiality of personal information

• Freedom from retaliation when voicing concerns or grievances

• Access to house rules, expectations, and grievance procedures

• Practice religion or spirituality of choice

• Maintain personal property within house guidelines

Section 4: Resident Responsibilities

Residents are responsible for:

• Maintaining sobriety at all times

• Complying with all house rules, curfews, and policies

• Attending required meetings and recovery activities

• Submitting to random drug and alcohol testing

• Paying fees on time as agreed

• Treating staff, peers, and neighbors with respect

• Keeping assigned living areas clean and orderly

• Reporting relapses, cravings, or safety concerns immediately

Section 5: Zero-Tolerance Substance Policy

Civara Recovery maintains a zero-tolerance policy for:

• Alcohol

• Illegal drugs

• Misuse of prescription or over-the-counter medications

• Synthetic substances

Violation may result in immediate discharge.

Resident Initials

Section 6: Drug & Alcohol Testing Consent

I consent to random, observed, and/or scheduled drug and alcohol testing as required by Civara Recovery. Refusal to test is considered a positive result.

Resident Signature

Date

Section 7: Medication Disclosure & Responsibility

Current Medications (Prescribed Only)

Resident Initials I agree to disclose all medications upon intake

Resident Initials I understand medication misuse may result in discharge

Resident Initials I agree to comply with medication storage and accountability requirements

Section 8: House Rules & Structure

Residents agree to comply with, including but not limited to:

• Curfew requirements

• Chore assignments

• Mandatory house meetings

• Visitor and overnight guest policies

• Employment/job search expectations

• Transportation and sign-in/sign-out procedures

A full copy of House Rules is provided separately and incorporated into this agreement.

Resident Initials

Section 9: Grievance Procedure

Residents may file grievances without fear of retaliation.

Step 1: Submit written grievance to House Management

Step 2: Review within a reasonable timeframe

Step 3: Written response provided to residents

Residents may escalate concerns to appropriate oversight agencies if unresolved.

Section 10: Confidentiality Agreement

Civara Recovery respects resident confidentiality. Residents agree to respect the privacy of others and not disclose personal or recovery-related information about peers.

Resident Initials

Section 11: Relapse & Return-to-Treatment Pathway (Zero-Tolerance Protected)

Civara Recovery maintains a zero-tolerance substance use policy. Any confirmed use of alcohol, illicit drugs, or misuse of medications results in immediate discharge from the residence.

At the same time, Civara Recovery recognizes relapses as a potential part of the recovery process and is committed to supporting residents in accessing higher-level care when needed.

Relapse Response Protocol:

• Immediate Safety Assessment

• Zero-Tolerance Enforcement

• Return-to-Treatment Support

• Documentation & Notification

Eligibility for Future Readmission:

• Discharged residents are not guaranteed re-admission

• Consideration may include completion of higher level of care, accountability, compliance, and available bed space.

Resident Initials

Section 12: Discharge Policy

Grounds for discharge may include:

• Relapses or refusal to test

• Violence or threats

• Theft or property damage

• Repeated rule violations

• Non-payment of fees

Emergency discharge may occur when safety is compromised.

Section 13: Voluntary Participation & Acknowledgment

I acknowledge that my participation is voluntary, I have received and understand this intake packet, and I agree to abide by all Civara Recovery policies.

Resident Name (Printed)

Date

Signature

Intake Packet

Pre-Screening Questions

Section 1: Resident Information

Section 2: Admission Criteria Acknowledgment

Section 3: Resident Rights

Section 4: Resident Responsibilities

Section 5: Zero-Tolerance Substance Policy

Section 6: Drug & Alcohol Testing Consent

Section 7: Medication Disclosure & Responsibility

Section 8: House Rules & Structure

Section 9: Grievance Procedure

Section 10: Confidentiality Agreement

Section 11: Relapse & Return-to-Treatment Pathway (Zero-Tolerance Protected)

Section 12: Discharge Policy

Section 13: Voluntary Participation & Acknowledgment