AmericaSober

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

Select location *

Room type *

Select room type

First name *

Middle name

Last name *

Date of birth *

Sex *

Male

Female

Referral code

Preferred payment period *

Week

Month

How did you hear about us?

Phone number *

E-mail *

Additional emails

Current sources of income

Employment status *

Employed

Unemployed

Other

Comment

Employer's name

Employer's phone

Job Address

Job Description

Monthly Net Income USD

How long at current employer?

Years

Months

Emergency contacts

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

Are you probation? *

Yes

Supervising officer contacts

Your Full name *

Signature *

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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Application form

Sober house location

General information

Employment details

Emergency contacts

Drug-related information

Confirmation