Horizon House - Member Application

Vehicle Make & Model

License Plate Number

Plate State

Registration Expiration

How did you find out about Horizon House?

Counselor/Therapist

Friend/Family

Internet Search

Other

Do you currently have a sponsor?

Yes

If no, are you willing to get one?

Yes

How many times have you been in sober living before?

Were you ever asked to leave a sober living facility?

Yes

Please explain why:

Medical Conditions (Physical or mental health conditions we should be aware of)

House Expectations:

• Attend 5 AA/NA meetings per week
• Maintain employment or actively seek employment
• Complete assigned house chores
• Participate in weekly house meetings
• Submit to random drug screenings
• Respect house curfew and rules
• Maintain sobriety at all times

I certify that all information provided in this application is true and complete to the best of my knowledge.

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Date

⚠ Before You Submit

Please review all your answers carefully. Your complete and truthful information will help us determine the best pathway for your success. Our admissions team will review your application and contact you within 24-48 hours.