New Client Application Form

  • The fee for a semi-private room is $1050.00 per month and payments should be made prior to the 28th of each month. In addition, a one-week grace period will be given for late payments then a $10 late fee will incur for each week late. In the event you should relapse and want to come back/stay in the 11th Step House there will be a $500.00 “relapse fee”. There is an entrance fee of $2,000.00. Prior to moving into the 11th Step House the following payments are required: First month, last month, and entrance fees. ** The prorated amount is the period from the day you move in, to the end of that month. Example: Move in date is October 8th, the prorated amount would be $812.90 which is for 24 days @ $33.87/day.


    I have read, understand, and agree to do any house chores assigned to me. I have also read and understand the house rules and agree to abide by them. I will attend a minimum of four 12 Step meetings or faith based recovery meetings a week. In addition, I will attend and participate in the weekly house meeting. I further agree that I will abstain from using alcohol or any other mind altering chemicals while living in the 11th Step House. I also agree to allow the 11th Step House director, Linda Steward to have access to any and all of my medical or psychological records from any and all of my doctors or counselors.
    I agree that if I violate the above commitment/agreement, I will move out of the premises immediately. I also agree to submit to periodic drug testing. I am aware that even suspected usage of any type by the director or the assistant director of the house will be considered “using”. If this should happen, or I do not abide by the house rules, I will forfeit any right to a refund of unused fees or deposits. I further agree to give a written 30-day notice before moving out of the premises. I may use my last month’s deposit fee for the last month of my stay. If I am in violation of these rules or suspected of being in violation, the last month’s fees (30 days) are also forfeited.