Application THE NUMBER ONE REQUIREMENT IS A CLEAN DRUG AND 80-HOUR ALCOHOL SCREEN UPON ARRIVAL. ANY MOOD OR MIND ALTERING SUBSTANCE IS A VIOLATION OF OUR ADMISSION POLICY Current Living SituationOwnRentLive with someoneNo home Please provide an Emergency contact (required) We are here to save lives, not assist with a legal defense in upcoming court cases or provide stable housing to comply with a court order. BHR will NOT directly assist with your court case, transport you to court appearances or monitor your progress for court officials. We strongly advise you to work with our partner Eugene Kaplan Counseling for specialized legal and family services that we cannot directly provide. COSTS INVOLVED: PHASE 1 (28 days) = $875 PHASE 2 $150/Weekly PHASE 3 $125/Weekly ALL JOBS ARE ARRANGED AT SUPPORTIVE LOCAL BUSINESSES WITHIN SAFE WALKING DISTANCE WITH OTHER RESIDENTS. You will receive a fair wage to support yourself and rebuild your life. Working alongside others in recovery at a partner business is part of our program it is NOT optional. If you are restricted from working full time due to disability/SSI payments you will not be accepted. EBT nutrition cards are not permitted on our campus because we are self-supporting individuals that receive fair wages while enrolled. By submitting this application you agree not to enroll in school during your residency. Please understand that while we provide low cost housing, WE CANNOT OFFER FREE SERVICES and will not process those applications. We do not allow new admissions to start work immediately and cannot accept IOU arrangements. You must follow up your application by initiating a phone interview. The applicant needs to personally submit his own application and personally make the phone call to follow up on the status of that application; we will not discuss your case with your family or your attorney. This is not a “diversion” program and we do not provide legal assistance for incarcerated persons. We operate on a first come first basis and do not take reservations or “hold” beds. Choose below: Phase 1 Residency Only (28 days)Long Term 3 Phase Commitment Requested date of arrival Payment arrangements must be confirmed in advance before a bed can be reserved. This can be paid in person upon arrival or on the “submit payment” page of this website. DO NOT PAY A DEPOSIT IF YOU HAVE NOT BEEN CONFIRMED FOR A BED. If you are being funded by an organization or relative please indicate that below. After acceptance, study the web page called “pre-arrival checklist” to become prepared. Explain your funding for the $875 admission cost here: In a few sentences explain why you should be considered for admission? Please explain. RESIDENTS ARE NOT PERMITTED TO LEAVE for outside obligations or commitments during the six week probation period. Not for court or any other reason. Are you aware of any outside complications (business or personal commitments, child support or civil hearings, psychiatric concerns or medical appointments) that may interfere with your ability to fully participate in your first six weeks of residency? Please explain. SUBSTANCE INFORMATION Have you ever had an overdose? YESNO Are you fully detoxed from all substances? (CAUTION: YOU WILL BE TURNED AWAY IF YOU CANNOT PASS A DRUG AND 80 HOUR ALCOHOL SCREENING) YESNO Beach House Recovery is not a healthcare facility, therefore every resident must be successfully detoxed before admission to the program and test clean upon arrival. Unfortunately, we are not equipped to treat those with a major mental health diagnosis. We do not allow ANY medication which has the potential to be abused regardless of prescription or purpose. We do not allow psychotropic medications used for major mental health disorders. Every prospective resident is asked to submit to a drug and alcohol test immediately prior to their admission and will be turned away if positive. HEALTH INFORMATION How would you describe your physical health?GOODFAIRPOOR WE DO NOT ALLOW commonly abused sleep medications (ex: trazodone or cymbalta), WE DO NOT ALLOW commonly abused mood stabilizers (ex: gabapentin or buspar) and WE DO NOT ALLOW commonly abused depression pills (ex: seroquel or remeron). If the medication alters your mood or your mind in high dosage you CANNOT BRING IT HERE. Have you been previously infected with covid 19? YESNO Have you been fully vaccinated for covid 19? YESNO Any mental health conditions? YESNO Prescribed medications? YESNO Physically willing and able to work? YESNO Upon entering phase 2 everyone must maintain full time employment and accept any local position available. We DO NOT allow local residents to maintain the current employer associated with their addiction. If you are opposed to accepting an entry level job you will not be a good fit. Explain your job skills and experience in the section below: Any physical limitations? YESNO Beach House Recovery is not a medical facility and does not employ a medical staff or dispense medication. This means that you may not be accepted as a resident if you are not healthy enough to participate in all aspects of the program or require regular doctor visits. Participants travel frequently and no one is left behind due to poor health. We never allow opioids or potentially abused medications regardless of the diagnosis. This is not an appropriate facility for those with a serious mental health condition. We do not allow “SGA” second generation antipsychotics, mood stabilizers or sleeping medications. We have no mental health professionals to assist you. EDUCATION Can you read? YESNO Can you write? YESNO LEGAL INFORMATION On probation? YESNO Residents participate in functions that are sometimes outside of NC. You cannot be accepted if you cannot leave the state. It is your responsibility to make arrangements with your probation officer prior to admission. Can you legally leave state? YESNO Pending court dates? YESNO Are you a sex offender? YESNO (Due to zoning and insurance, we are unable to accept convicted sexual offenders) Do you have a valid ID in your possession? YESNO YOU MAY NEVER BRING OR STORE A VEHICLE IN THE CALABASH AREA UPON ADMISSION. Do you have a valid driver's license? YESNO A social security card is absolutely necessary. Do you have a social security card in your possession ? YESNO Please provide the last 4 digits of your social security number. Are you a convicted felon ? YESNO FAMILY INFORMATION Marital StatusMarriedSingleDivorcedSeparatedWidowed How Many Children?0123456+ Pay court ordered child support? YESNO Acknowledgments Please read the following statements carefully as they represent a digital contract. These items must be agreed to in order to submit your application and again upon arrival. Your acceptance is contingent upon a negative drug screen upon arrival and any subsequent positive screen will result in immediate discharge. Overwhelming suspicion of abusing OTC untraceable substances will result in eviction. Due to the minimal cost we will not issue refunds under any circumstances. Residents are never guaranteed transition or advancement into subsequent stages of the program beyond phase one. All records are kept private and confidential. I have carefully reviewed the guidelines, understand all policies and agree to the terms and conditions. I acknowledge that using or obtaining a mood or mind altering substance, prescribed or otherwise, will result in eviction. I understand that BHR is not responsible for lost, stolen or abandoned property and will not guarantee storage or investigate missing items. Your possessions are your responsibility at all times. I acknowledge I’m a guest, not a tenant, of Beach House Recovery. I will not establish legal residency, enter into a lease agreement or be promised any goods or services. I have been specifically advised that this is not a detox facility and we do not offer medical care. I understand that we do not offer mental health services beyond the scope of addiction. As a visitor I am not entitled to an eviction notice or arbitration if discharged. This arrangement will never change and I agree to leave upon request. WAIVER OF LIABILITY: I hereby assume all risk of injury or harm as a result of residency at Beach House Recovery and agree to release, indemnify, defend and forever discharge BHR from all liability, claims, demands, damages, costs, expenses, and causes of action due to death, injury, loss, or damage due to the undersigned. AGREEDISAGREE