Application form

  • Sober house location
  • General information
  • Employment details
  • Emergency contacts
  • Drug-related information
  • Confirmation

Sober house location

Select location
Room type

General information

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Employment details

USD

Emergency contacts

Add names, telephone numbers and relationship of two individuals who may be contacted in the event of an emergency.

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Confirmation

Draw a signature using the mouse or touch screen. It does not have to be perfect yet legible.

I agree with House Rules, Terms and Conditions and I certify it is my name

I acknowledge by my digital signature that I have read, understand, and agree to all Americasober policies, rules, and procedures outlined in the Americasober House Contract. Furthermore, I understand that continued membership at Americasober is contingent on my adherence to these policies and guidelines. I further understand that Americasober reserves the right to terminate my membership on a weekly basis. By digitally signing below I certify that the information submitted in this application is true and correct to the best of my knowledge and I am the person whose name appears below.

Thank you!

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