Recovery Starts Now

IMG_4469.JPG

We're so glad you're taking the first step in taking back your life from drugs and alcohol. Taking that first step can be hard and we appreciate your courage and drive to rid your life of your addiction once and for all. Below are the house rules. You can access these at any time here or in the about. You will also be given a copy upon being admitted to the residence. 

Please fill out the form below to get started:

Personal Information
Address *
Address
Phone *
Phone
Emergency Contact Info
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
Drug/Alcohol Abuse and Treatment History
Drug/Alcohol History *
What drugs have you abused?
Date since last use *
Date since last use
The use of any drug, if you're not entirely sure of the date of the month, provide your best estimate.
Expected Discharge Date
Expected Discharge Date
Legal Information
In the information box below, It is required to enter the Parole Officer's Name and Contact information (Email or Phone Number)
If you are not yet, but charges are pending which if found guilty would require you to register as a sex offender, please answer "yes" to both "charges pending" as well as this field and explain in the box below.
Medical Information
Use the box below putting each provider on a separate line along with what the plan covers in general (general healthcare, dental, vision, etc)
Please list any prescriptions you are taking under advice of a doctor, the dosage, frequency, and the condition being treated, or if not on any medication, put "none"
Doctor's Phone Number
Doctor's Phone Number
Please list anything you are allergic to along with what happens if you are exposed to it (e.g. Peanuts - Break out in hives) as well as any medical conditions you may have (Bipolar Disorder, Carpal Tunnel Syndrome, etc) putting each allergy/condition on a separate line. If you do not have any allergies or medical conditions apart from your addiction, put "none"
Employment Information
Supervisor's Name
Supervisor's Name
If you have a flexible schedule, please describe your availability and the operation hours of where you work, if you are in a monday through friday job, put your arrival and end times for work and what days you work.
Acceptance and Verification
I Agree to the terms and conditions *
By writing your full name, you accept and agree to the above statement.

BRIDGEWAY HOUSE “ZERO TOLERANCE” POLICY:

1.           ZERO Tolerance for drug or alcohol use. (No engaging in illegal substance manufacturing, possession and/or distribution will be tolerated.

2.           ZERO Tolerance for stealing. (e.g., taking food from others without permission is considered stealing). 

3.           ZERO Tolerance for destruction of the “BridgeWay House” or other residents’ property.

4.           ZERO Tolerance for sexual activity or harassment between residents.

5.           ZERO Tolerance for physical confrontation or verbal confrontation with any staff or resident. No abusive behavior, threats of violence, obscene gestures, or weapons of any kind are permitted.

*As a member of a recovering community, based on the principles of honesty, trust and helping to create a safe and sober environment, we request any resident who knows that another resident has violated any rules of the “BridgeWay House” report the behavior to staff.

** Please read the full rules and regulations HERE before applying.