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									The Shepherd’s Shelter
Adult Substance Abuse Center

236 Bridgett Drive Mt. Sterling, KY 40353 859-498-7111

Fax 859-498-7100 Intake Packet

The Shepherd’s Shelter is very pleased that you have recognized a need for help in the areas that have been controlling your life. We are glad you have contacted us here in Mount Sterling to help you that that initial steep toward a new life in Christ. You now have an opportunity to join others who have made this commitment to go on with their lives. It is very important that you understand who we are and what we expect before enrolling, so that you will be confident you are entering the right program for you. Therefore, you will need to read all this material thoroughly and make a thoughtful decision based upon your desire to have a change in your life.

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The Shepherd’s Shelter Resident Application
236 Bridgett Drive, Mt. Sterling, KY 40353 Phone: 859-498-7111 Every question must be completed and your picture enclosed, before your application will be considered. Please be descriptive in your answers. You must call once each week to verify your continued interest in our program to keep your name on our active list. Place Your Picture Here

1. GENERAL Name: ____________________________________________________ Present Address: ____________________________________________ City: ________________________State:__________Zip: ___________ Phone: ( ) ____________________ Referred to Shepherd’s Shelter by: ______________________________ In case of emergency Notify: _____________________________Relationship:_____________ Phone: ( )___________(home)( )_____________(work)( )________ Address: __________________________________________________ City: _______________________State: ___________Zip: __________ 2. PERSONAL Date of Birth: ____________Age:______ Weight: _______ Ht:________ Birthmarks or tattoos _______________________________________________________________________ ___________________________________________ Race: _____________ Social Security Number: ____________________ Driver’s license State and Number: ______________________________ What are your present living conditions? __________________________ _________________________________________________________ _________________________________________________________

Last

First

MI

Maiden

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How are you supported?_______________________________________ Marital Status: Single: _____Engaged _______Common-law_______ Married ______ Separated ______ Divorced _____ What is your relationship with your husband/wife Girlfriend boyfriend now? _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ Would you say that your spouse/significant other has a drug or alcohol problem? __________________________________________________ _________________________________________________________ Do you have any children? ___________ How many?__________________ Custody: (Me) ________ Other: ________________________________ Education/Training: Last grade completed: ________________________ Have you ever been in special education classes: _____________________ Have you ever been involved in prostitution? ________________________ When and how long were you involved? ____________________________ 3. EMPLOYMENT Do you work? __________ Where do you work? ____________________ What type of jobs have you held in the past? _______________________ _________________________________________________________ _________________________________________________________ When was your last job? ______________ Type of job? ______________ What kind of job or trade would you like to learn? ___________________ _________________________________________________________ 4. LEGAL STATUS Have you ever been arrested? _________ How many times?____________ List all charges: _____________________________________________ _______________________________________________________________________ ___________________________________________ Are there any pending charges against you? ________________________

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Are you on probation/Parole? _______ Where?_____________________ Name of Probation/Parole officer: _______________________________ Address: __________________________________________________ City: __________________________State _______ Zip: ___________ County: _____________________Phone ( ) _____________________ Have you ever served time in prison? _______ When? ________________ Where?___________________________________________________ _________________________________________________________ Offense(s)/Crime(s) _________________________________________ _________________________________________________________ _________________________________________________________ Name of Lawyer: ____________________________________________ Address: __________________________________________________ City: __________________________State_________Zip___________ Phone ( )____________________ 5. SPIRITUAL Are you a born again Christian? ___________ Do you believe in God? ____________ How do you describe your relationship with God now? _________________ _________________________________________________________ _________________________________________________________ 6. THE PROBLEM What do you consider your main problems? _________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ What efforts, if any have you made to correct these problems? _________ _________________________________________________________ _________________________________________________________ _________________________________________________________ Have you ever been in an out patient program? ______________________ Did you finish treatment? _____________ Have you ever been to Detox? _______ How many times? _____________ Did you finish? _____________ Have you ever been in other in patient programs?__________ Please list: ______________________________ _________________________________________________________ _________________________________________________________

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_________________________________________________________ 7. HEALTH Write yes or no beside the following illnesses or conditions that you have had. If yes, please write the date, to the best of your knowledge. Scarlet fever _____ measles _____ Chicken pox _____ mumps _____ Whooping cough _____ small pox _____ Typhoid fever _____ cancer _____ Syphilis _____ gonorrhea _____ Diphtheria _____ pneumonia _____ Nervous breakdown_____ diabetes _____ Migraines _____ high blood pressure_____ Do you have a special diet requirement due to allergies or medical reasons? Explain ___________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________ What is the average amount of each substance you have consumed daily? Alcohol _____ heroin ______ Cocaine _____ opiates ______ Glue _____ tobacco ______ Marijuana _____ crack ______ Crank _____ valium ______ Uppers _____ downers ______ Hallucinogenics _____ ecstasy ______ Meth _____ xanax ______ Other prescription drugs: (list name and amount)_____________________ _________________________________________________________ Other drugs: (list name and amount)______________________________

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STATEMENTS OF RELEASE

I certify that all information here is accurate and true to the best of my knowledge. I understand that any false or incomplete information may result in disqualification of any application for entrance. Signed: ______________________________________________
Applicant Date

Of forms were physically completed by anyone other than applicant, fill in below. Person _______________________________________________ Relationship to Applicant: _________________________________

It is hereby understood that Shepherd’s Shelter is not responsible for any resident’s personal property left, lost, or stolen while in the program. I agree that any property or money left at Shepherd’s Shelter over 24 hours from my departure date, announced or unannounced, becomes the property of Shepherd’s Shelter. Signed: ______________________________________________
Applicant Date

It is further understood that I release Shepherd’s Shelter/Ross Rehab from all financial responsibilities in case of an accident, injury, illness or other imponderable misfortune. Signed: ____________________________________________
Applicant Date

It is further understood that I release the right to Shepherd’s Shelter/Ross Rehab to search my personal effects, make room searches, make a physical search and do drug testing without prior notice to me. Signed: _____________________________________________
Applicant Date

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Procedure for Incoming Referrals

Clients wishing to enter Shepherd’s Shelter Adult Substance Abuse Treatment Center must contact our intake staff. The client seeking entry must make this contact personally. The Intake Staff are the only people who can accept referrals. 1. Arrangements for entrance MUST be confirmed prior to arrival 2. Each client is limited to ONLY TWO suitcases. 3. Each client MUST mail in Shepherd’s Shelter the Physical Exam Form and copy of Social Security Card. 4. Prior to confirming the client’s entrance date a $600.00 non-refundable first month’s payment MUST accompany the above –mentioned documents. 5. All clients not from the local area must arrive with documentation of their ability to return to their residence if/when needed. Case or Money Orders ONLY are accepted. M.O. must be made Shepherd’s Shelter/Ross Rehab. Monthly Tuition: $600.00 per month, due at the beginning of each month. Should you have any further questions, please do not hesitate to contact our office. Office Hours: Monday-Friday: 9:00 a.m. to 6 p.m. payable to

God Bless you in your decision!

____________________________________
Client Signature Date

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What to Bring
Maximum allowance items 1. Identification: Any 2 of the following:  Birth certificate  Driver’s License  Social Security Card  Picture ID Personal Items:  Toothbrush, toothpaste, dental floss  Hair dryer  Nail clippers  Notebook paper, pen/pencils  Envelopes; stamps  Bible  Cosmetics  Brush, combs, hair scrunchies, etc.  Toilet paper and paper towels  Laundry basket or bag

2.

Clothing: (please limit to one suitcase and overnight bag) Limit 1-2 of each item; limited closet space Women (suggested items; not required)  Dress  Blouse  Skirt  Casual pants  Blue jeans  T-shirts  Socks  Casual and dress shoes (athletic, sandals, heels, flats)  Flip-flops (for shower) or casual wear  Coat (during winter months)  Jacket or sweater  Appropriate sleepwear  Undergarments (no thongs)  House slippers  sweats No clothing that has offensive logos or slogans is permitted. Tight fitting or seductive clothing is not permitted. No tank tops or tube tops. 9

3.

Men (suggested items; not required)  Shirts (button front; polo; and t-shirts) both dress and casual  Jeans  Casual pants  Casual shoes (athletic shoes, work shoes)  Dress shoes  Belts  Underwear (no thongs)  Robe  House slippers  Flip flops (for shower) or casual wear  Coat (winter months)  Jacket  Sweats  Socks No clothing that has offensive logos or slogans is permitted. Shirt must be worn at all times outside your room. No pants that sag so as to show underwear are permitted. No tank tops (beaters) are permitted accept as an under shirt. No Cell phones, M P 3 players, I pods, C D players, radios, televisions or pagers ETC.

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FEE AGREEMENT This Fee Agreement is made and entered into this “Rehab Facility”); and (hereinafter referred to as “Resident”); and (hereinafter referred to as “Guarantor”). day of , 20__, between, The

Shepherd’s Shelter - Ross Rehab, 236 Bridgett Drive, Mt. Sterling, Kentucky 40353 (hereinafter referred to as

The Parties agree as follows:

1.

The term of this agreement is for _6____ months, beginning on ____________ ______ and ending on _________________20__

2.

The monthly fee for Resident residing at the Rehab Facility is $__600.00_____ per month and is due and payable on or before the 1st of each month.

3.

The payment of the above-referenced monthly fee is guaranteed by ,

4.

If for any reason the monthly fee remains unpaid for a period of __5___ days after the above-established due date, the account will incur a $25 late fee. A $5 daily fee will be attached for every day after the 5 th day for 14 days. If the debt is not paid after 14 days, the client will be immediately discharged. If the Resident is at the Rehab Facility by means of a Court Order, the appropriate officials will be notified and the Resident will be immediately returned to jail. I fully understand that under no circumstances will any monies be refunded no exceptions. The Shepherd’s Shelter - Ross Rehab

By:

Resident - Signature________________________________ Guarantor - Signature ______________________________

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Shepherds Shelter/Ross Rehab
236 Bridgett Drive shepherdshelter@bellsouth.net / shepherdshelter.com Mt.Sterling, Kentucky 40353 Phone (859) 498-7111 Fax (859) 498-7100

RELEASE OF MEDICAL OBLIGATION AND WAIVER
I, _________________________________, a patient at the Shepherds Shelter/Ross Rehab (hereinafter “the Rehab”), hereby release the Rehab, Pastor Wayne Ross, or any individual designated by the Rehab or Pastor Ross, working on behalf of the Rehab, of any responsibility, financial or otherwise, for any medical condition, medications required or physiological treatment, regardless of my medical and/or mental condition, pre-existing or acquired after becoming a resident at the Rehab. I further acknowledge and understand that the Rehab, Pastor Ross or any member, volunteer or individual designated by the Rehab will not be responsible for providing any form of medical treatment. I further release the Rehab, Pastor Ross and any other member, volunteer or individual associated or designated by the Rehab from any liability regarding any accidents, injuries or losses incurred while a resident at the Rehab. And, further understand and acknowledge that I am solely and financially responsible for any and all costs incurred for medical treatment therein. This document is being signed by me, constituting my free act and deed with the knowledge that I do not have to sign this document, but choose to do so. This the ____ day of ______________________________, 20____.

________________________________ Patient/Client Shepherd’s Shelter/Ross Rehab BY:________________________ TITLE:_____________________

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Shepherds Shelter/Ross Rehab
236 Bridgett Drive shepherdshelter@bellsouth.net / shepherdshelter.com Mt.Sterling, Kentucky 40353 Phone (859) 498-7111 Fax (859) 498-7100

EBT/FOOD STAMP CARD USE AUTHORIAZATOIN
I, _________________________________, a patient at the Shepherds Shelter/Ross Rehab (hereinafter “the Rehab”), hereby authorize the Rehab, Pastor Wayne Ross, or any individual designated by the Rehab or Pastor Ross, working on behalf of the Rebab, to use the EBT/Food Stamp Card that has been issued in my name while I am a resident at the Rehab. I acknowledge and understand that this EBT/Food Stamp Card is being used for my benefit and regardless of whether I am a resident of the Rehab for the complete month (i.e., thirty days) or less than thirty days, there will be no refund or release of any amounts on the EBT/Food Stamp Card, should I choose to leave the Rehab before the last day of the month for the monthly issue of funds on the EBT/Food Stamp Card. This document is being signed by me, constituting my free act and deed with the knowledge that I do not have to sign this document, but choose to do so. This the ____ day of ______________________________, 20____.

________________________________ Patient/Client Shepherd’s Shelter/Ross Rehab BY:________________________ TITLE:_____________________

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Shepherd’s Shelter/Ross Rehab
Waiver for Mail Screening
I hereby waive my privacy rights concerning all mail at this facility. I understand that at any time, and at their discretion, the staff of Shepherd’s Shelter may choose to screen my mail regarding contact that I may try to make with individuals that the leadership of this facility regards as a detriment to my progress in the program. I also waive my right to receive mail from anyone while at this facility, unless it regards legal or business matters. By my signature I hereby acknowledge that I have read and understand the elements of this waiver.

________________________________________ Signature of Resident

________ Date

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Shepherds Shelter/Ross Rehab
236 Bridgett Drive Mt.Sterling Kentucky 40353 shepherdsshelter@bellsouth.net shepherdsshelter.com 859-498-7111 fax 859-498-7100

Release of information form
I herby give my consent for Shepherds Shelter/ Ross Rehab and or Pastor Wayne Ross to release my personal information to anyone in the court system family member’s doctor’s medical staff regarding my stay and progress in the program. I further understand that this information is to be released only to the involved parties.

Director _____________________________________Date _______________________ Client________________________________________Date_______________________

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Shepherds Shelter/Ross Rehab
236 Bridgett Drive shepherdshelter@bellsouth.net / shepherdshelter.com Mt.Sterling, Kentucky 40353 Phone (859) 498-7111 Fax (859) 498-7100

STRIP/BODY CAVITY SEARCH
I, _________________________________, a client/patient at the Shepherds Shelter/Ross Rehab (hereinafter “the Rehab”), understand that I am subject to a Strip and/or Body Cavity Search upon entrance to the Rehab, or at any time thereafter. I further understand that should drugs, drug paraphernalia or any other contraband be found on my body or in my possession, said item or items will be confiscated and appropriate legal action will be taken by the Rehab, its owners, agents or assigns. I have read the foregoing document and understand the terms and conditions of this document. This the ____ day of ______________________________, 20____.

________________________________ Patient/Client Shepherd’s Shelter/Ross Rehab BY:________________________ TITLE:_____________________

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Visitation Times

Sunday 2:00 p.m. church service Sunday visitation 3:00-5:00 p.m. Tuesday church service 7:00 p.m.

Wednesday visitation 5:30 -7:00 p.m. Wednesday church service 7:00 p.m. Saturday church service at 6:00 p.m.

Visitors are welcome to attend church services .

Phone calls Friday between 3:00-5:00 p.m. for females.

Clients are not allowed to have visitors for the first 30 days.

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SHEPHERD’S SHELTER VISITOR RULES 1. Visitors of Shepherd’s Shelter residents are required to leave all belongings (purses, tote bags, wallets, etc.) in their cars before entering the building. 2. Visitors must provide a picture ID to staff members before being allowed contact with residents. 3. Any contraband found on a visitor during a visit will be considered a deliberate attempt to make contact with a resident in order to jeopardize his/her sobriety and will result in immediate confiscation of the contraband. If the contraband is drug related, the police will be called and the visitor will be prohibited from future visits to the Shepherd’s Shelter. 4. Visitation is confined to the front lobby. Visitors are allowed to use the restrooms located in the lobby. Walking with or without residents around the building, down resident hall ways, or standing on the porch and front yard areas is prohibited. 5. The lobby/handicapped restrooms are for visitors only and residents will not be allowed in them. Visitors may not use any other restrooms in the facility. 6. Visitors may not leave the facility and return to their car during a visit. Once a visitor leaves, he/she will not be allowed back inside the facility or to make contact with a resident during the visit. 7. Shepherd’s Shelter management and/or staff reserve the right to require a search of any visitor who is suspected of having contraband on their person. We also reserve the right to drug test any and all visitors. Failure to comply with a random search will result in immediate expulsion from the facility. 8. Failure on the part of any visitor to comply with the rules explained herein will result in relinquishment of visitation privileges until/unless visitor agrees to comply with visitation rules. 9. We reserve the right to cancel visitation at any time without prior notice.

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Shepherds Shelter/Ross Rehab
236 Bridgett Drive shepherdshelter@bellsouth.net / shepherdshelter.com Mt.Sterling, Kentucky 40353 Phone (859) 498-7111 Fax (859) 498-7100

RELEASE OF INFORMATION
I, _________________________________, a patient at the Shepherds Shelter/Ross Rehab (hereinafter “the Rehab”), hereby authorize the Rehab, Pastor Wayne Ross, or any individual designated by the Rehab or Pastor Ross to release any information regarding my status at the Rehab, to requesting members of the Court and/or Judicial System, Family Member’s (unless otherwise requested not to receive information), any medical doctor known to be treated by me, and any other medical staff member regarding my stay and or progress while a participant in the program offered by the Rehab. I further authorize and release the Rehab, Pastor Wayne Ross, and any other person designated by the Rehab from any liability issue regarding the release of such information. This document is being signed by me, constituting my free act and deed with the knowledge that I do not have to sign this document, but choose to do so. This the ____ day of ______________________________, 20____.

________________________________ Patient/Client Shepherd’s Shelter/Ross Rehab BY:________________________ TITLE:____________

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Shepherds Shelter Ross Rehab
We are faith based rehab you are expected to comply with these rules. In the event any rule is violated, you will receive a written warning. Upon receiving three (3) written warnings, you will be asked to leave the Facility.

CHORES / TASKS
1. 2. You are expected to do daily chores, yard work and maintenance while at this Facility. You will be given a daily chore list that you must complete. When asked to perform task, you are required to perform that task immediately, not one or two hours later. Failure to cooperate with Supervisors will result in a written warning.

CHURCH SERVICES / SUPPORT MEETINGS
3. You are required to attend all church services, group meetings, daily prayer circles, bible studies and other various meetings at the Facility without exception. While in attendance you are expected to participate as well as sit uprightly, stand when you are directed to do so and stay until you are dismissed.

CLOTHING
4. Shirts, t-shirts or any other clothing that has secular names, music groups, alcohol, drugs, sexual or any other inappropriate logo are not permitted.

COMPLETION OF PROGRAM - LEAVING PROGRAM
5. Upon completion of or dismissal from the program, you must remove your belongings within 24 hours. We are not a storage center and will dispose of your belongings after 24 hours.

CONFLICT
6. If you have a problem or issue you are to work it out with your Supervisor. Your Supervisor will speak with Pastor on your behalf if necessary. If the problem does not get resolved or you have a personal issue for which you need counseling, you are permitted to speak with Pastor or Donna yourself.

CONDUCT
7. You are expected to conduct yourself in a respectful and cooperative manner with all Staff as well as other residents. Bad attitudes disrespect, threatening and violence of any kind will not be tolerated. In the event you strike another person or destroy property, you will be removed from the Facility and prosecuted. Physical contact and horse play are not permitted.

8.

DATING
9. Residents are not permitted to date each other or any other person while in this program. There will be no public displays of affection on this property (i.e., hugging, kissing, etc.). Residents are never permitted to be alone with a person of the opposite sex.

DEVOTION
10. You are required to spend at least ½ hour per day, everyday, in religious and devotional time. This time is for reading scripture, prayer and meditation.

DRUG TESTING
11. At the sole discretion of Staff there will be random drug testing and searches of your person, property and room. You will be drug tested and charged a ten dollar fee to pay for the drug test every time you return to the Facility after off premises visitations.

EMPLOYMENT
12. You will not be permitted to work a job outside while you are a resident here.

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FRONT OF PROPERTY
13. You are never permitted on the front of the property for any reason unless you have been assigned yard work or outside maintenance in that area.

GAMES
14. Games are allowed only at Staff discretion and/or your Supervisor’s express permission.

HOUSEKEEPING
15. Male residents are NEVER permitted on female wings, nor are female residents permitted on male wings. 16. You are not allowed to go into another person’s room for any reason. 17. Since many people come through the Facility, we ask that you get dressed in your own room and also that males wear shirts at all times. You are not permitted to wear pajamas or slippers outside your wing. 18. Your room must stay clean, organized and free of clutter at all times. You must clean your room every morning before your day starts - this includes making your bed. Do not leave your room in the morning until your bed is made. 19. If you are in a room that sleeps two, you may only use one-half (1/2) of the closet and drawer space - no exceptions. 20. You are expected to clean up after yourself. If you make any kind of mess you are to clean it up immediately. 21. You are not allowed in the kitchen for any reason unless you have kitchen duty. 22. You are to shower every other day. Showers are limited to seven (7) minutes. 23. You are not permitted to be in your room until after 8.00 p.m. daily, except in the case of sickness, or to change clothes. 24. Heat and A/C units in your room may only be turned on and remain on while you are in your room and must be turned off when you leave your room and ½ hour before bedtime nightly. 25. You must be indoors by 10:00pm as bedtime curfew is 10:30pm with the exception of Friday nights, which is 11:30pm.

LAUNDRY
26. You are allowed one (1) wash day per week. In addition to your regular laundry, your bed linens must be washed every week on that day. Laundry will cost $3.00 per load.

LEAVING PREMISES
28. You are not allowed, under any circumstances, to leave the premises without express permission and supervision. If you have permission and you do leave, you are to sign out and back in when you return.

MONEY & OTHER ITEMS
29. You are not allowed to have any form of currency (money, food stamp card, etc.) in your possession at any time while you are a resident here, nor are you allowed to receive any other items directly. You must direct family and friends to give all monies and items to your Supervisor or Staff. Money will be locked in the safe. Your Supervisor will keep track of your money for you and will have to approve as well as supervise any spending. Your Supervisor will give you any personal items after they have been searched and approved. 30. You are required to contribute a minimum of $200.00 cash or food stamp card per month for the cost of your food while you’re here. 31. Your monthly fee to be a resident of this facility is $600.00.

MUSIC
32. No radios, ipods or CD Players are permitted.

PHONE
33. The phone times at the Shepherd’s Shelter are: 2-5 p.m. Thursday and Friday only.

One call may be made or received during this time
Residents must sign a phone list before making calls; calls will be made according to your place on the list. Calls are limited to 5 minutes. Exceptions will be made only in the case of real emergencies. You are not allowed to have a cell phone or pager - these must be turned into to your Supervisor.

SMOKING
34. Smoking is permitted, however, only in designated areas and at designated times, before 10:00 p.m. You are not allowed to exit the facility after 11:00 p.m. to smoke or for any reason.

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SOCIAL GATHERINGS
35. Social gatherings and contact between male and female residents and visitors must be in view of others at all times. You are never permitted to go anywhere on the property alone, with another resident or a visitor.

TRANSPORTATION
36. The church van is for resident transportation to and from church services and transportation to the store, doctor, pharmacy, food stamp office, etc. If you need to go to court you will have to arrange a ride with a family member who has been pre approved by pastor (no boy friend or girl friends will be allowed to transport you at any time).

VISITATION
37. Visitation is permitted on Sunday (3pm-5pm); Wednesday (5:30 pm-7 pm). Visitors who wish to stay for church are welcome to do so. 38. No visitors are allowed on this property to visit you or to drop off anything other than during regular visiting hours set forth in #37 (above). Other visitation may be permitted only if prior permission is given by Pastor. If someone shows up at a time other than regular visitation hours and they have not obtained prior permission from Pastor or your Supervisor, they will be asked to leave. An exception for a brief few minutes may be made if it is a family member from out of town. This exception is at your Supervisor’s discretion This list of Rules is not meant to be all inclusive. Therefore, Staff reserves the right to add to, delete and/or change rules at their discretion as they see fit.

I have read and agree to adhere to the rules as listed above. I fully understand these rules. I further understand that if I break these rules I may be asked to leave this Facility. I also understand that if I am asked to leave, under no circumstances will any money paid be refunded—no exceptions.

Resident

Date

Director

Date

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Procedure for Incoming Referrals

Clients wishing to enter Shepherd’s Shelter Adult Substance Abuse Treatment Center must contact our intake staff. The client seeking entry must make this contact personally. The Intake Staff are the only people who can accept referrals. 6. 7. 8. 9. Arrangements for entrance MUST be confirmed prior to arrival Each client is limited to ONLY TWO suitcases. Each client MUST mail in to Shepherd’s Shelter a copy of Social Security Card. Prior to confirming the client’s entrance date a $600.00 non-refundable first month’s payment MUST accompany the above –mentioned documents. 10. All clients not from the local area must arrive with documentation of their ability to return to their residence if/when needed. Cash, check, or Money Orders ONLY are accepted. M.O. must be made payable to Shepherd’s Shelter/Ross Rehab. Monthly Tuition: $600.00 per month, due at the beginning of each month. Should you have any further questions, please do not hesitate to contact our office. Office Hours: Monday-Friday: 9:00 a.m. to 6 p.m.

God Bless you in your decision!

____________________________________
Client Signature Date

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