Online Application

GENERAL INFORMATION









Residents are highly encouraged to complete our four week onsite intensive program prior to entering the recovery community. This is an optional one time investment of $775. Our donors occasionally make partial scholarships possible based upon availability and funding. Offsite housing options begin at $110/week with an initial non refundable entry fee of $110.
Onsite PHASE ProgramOffsite Structured Housing

Requested date of arrival

Are you financially able to reserve a bed if accepted? Please explain.

Are you eligible and/or receiving EBT nutrition benefits? Please explain.

SUBSTANCE INFORMATION



Previous Recovery Centers? YESNO


Have you been through detox? YESNO

Beach House Recovery is not a medical facility, therefore every resident must be successfully detoxed before admission to the program. Every prospective resident is asked to submit to a drug and alcohol test immediately prior to their admission.

HEALTH INFORMATION


Any Medical Conditions? YESNO

Prescribed Medications? YESNO

Physically able to work? YESNO

Any Physical Limitations? YESNO

Beach House Recovery is not a medical facility and does not employ a medical staff. 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.

EDUCATION

Can you read? YESNO

Can you write? YESNO

LEGAL INFORMATION

On probation? YESNO



Residents participate in fundraiser trips that are sometimes outside of NC. You may not be accepted if you cannot leave the state.

Can you legally leave state? YESNO

Pending court dates? YESNO


Are you a sex offender? YESNO

Due to zoning, we are unable to accept convicted sexual offenders.

(valid identification is required to enter the program)

Do you have a valid ID? YESNO

Valid driver's license? YESNO

Do you have a lawyer? YESNO

FAMILY INFORMATION






Pay court ordered child support? YESNO

Acknowledgments

Please read the following carefully. These items must be agreed to in order to submit your application.

I have carefully reviewed the program guidelines and agree to the rules, terms and conditions.

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. As a visitor I am not entitled to an eviction notice or arbitration if dismissed. This arrangement will never change and I agree to leave upon request.

ADDITIONAL COMMENTS