Treatment Application

  • PERSONAL INFORMATION

  • Street Address
  • Address Line 2
  • City
  • State / Province / Region
  • ZIP / Postal Code
  • Street Address
  • Address Line 2
  • City
  • State / Province / Region
  • ZIP / Postal Code
  • ARRIVAL INFORMATION

  • Personal Items

    Upon arrival at Roots Recovery Houses all property will be searched and inventoried. This is done to keep the residents and the community safe. Items that are inappropriate will be held in the safe, disposed of or donated to charity
  • Things You May Bring

    • ONE suitcase and ONE backpack maximum
    • Cloth laundry bag
    • Set of towels
    • Laptop, cell phone (will be held by staff for length of time determined appropriate by staff)*
    • Driver’s license or passport, social security card (can be held in safe)
    • Backpack / Knapsack
    • Resume and references
    • Nice clothes for job interviews
    • Insurance card
    • All prescription medication
    • Toiletries (alcohol-free)
    • Appropriate reading material (bring a Big Book, 12 Steps & 12 Traditions and Twenty Four Hours a Day if you already have them)
    • iPod or other personal music listening device (use may be restricted as determined by staff)
    • Musical instruments for use during leisure time
    • Athletic wear (t-shirts, shorts, sweatpants, etc.)
    • Swimming suit
    • $50 dollars cash ONLY (use may be restricted as determined by staff)
  • Things You May Not Bring

    • Weapons, including pocket knives
    • Drugs or Alcohol
    • More than one suitcase and one backpack of clothing
    • Heating pad or electric blankets
    • Pets
    • Gaming systems
    • Drug paraphernalia
    • Clothing or other items suggestive of alcohol or drug use, promoting sexism, racism or homophobia
    • Valuable jewelry or expensive clothing
    • Pornography
  • Note: any and all personal belongings left on the premises of Roots Recovery Houses LLC for more than 24 hours after voluntary or involuntary discharge from the Roots Recovery program become the property of Roots Recovery Houses LLC and by signing below I give Roots Recovery Houses LLC permission to dispose of these items however they see fit. By signing below I also agree that any theft, loss, or damage of any kind to any personal property is not the responsibility of Roots Recovery Houses LLC and that I will not hold Roots Recovery Houses LLC responsible. Items of personal or monetary value should not be brought to the facility.

  • ARRIVAL INFORMATION

  • Initial Fee of $700 Includes:

    • Processing
    • Orientation and Program Introduction
    • 4 $50 Grocery Cards
    • First Month’s Housing
    • Utilities
    • Milwaukee Transit Pass
    • Urine Testing
    • Laundry detergent, paper products, cleaning supplies, hand soap
  • Subsequent Monthly Fee of $500 Includes:

    • Housing
    • Utilities
    • Milwaukee Transit Pass
    • Urine Testing
    • Laundry detergent, paper products, cleaning supplies, hand soap
  • Roots Recovery Houses fees are non-refundable. Payment is accepted by certified cashiers check or via credit card by PayPal.

    Applicants must arrange their own transportation to Roots Recovery Houses.

    The first month’s fee may be paid by a family member. After the first month, all residents are required to pay all of their own fees.

  • The applicant for residency at Roots Recovery Houses hereby warrants the truthfulness of the information provided in this application.

  • ARRIVAL INFORMATION

  • Honesty, integrity, discipline, and service are the foundation of the Roots Recovery program. All residents must strive to represent these tenets in their daily life. Living a sober life is about more than finding freedom from addiction, it is about developing and maintaining a personal moral code.

    Racism, sexism, homophobia, or any comments, attitudes, and/or behaviors that are derogatory towards any group or individual are not acceptable in any context or circumstances at any time and are grounds for expulsion.

    Any behavior that constitutes bullying as determined by the Roots Recovery community is grounds for immediate expulsion.

    Roots Recovery Houses require a 6-month commitment, this program is not a month-to-month living situation. If a resident decides that they do not want to complete the entire six-month program, they must leave immediately.

    Contact with family, friends, or significant others is suspended for a minimum of 30 days. This restriction will be lifted at the discretion of the house manager based on the resident’s progress and may last longer than 30 days. Family and friends are expected to adhere to this restriction. Family members, friends, or significant others who break this restriction may cause the resident’s expulsion from the program.

    Residents must participate in a 12 step program AND the Roots Recovery community. This includes but is not limited to; attendance at a minimum of 1 outside 12 step meeting per day on workdays and 2 on any days off, acquiring a sponsor within 1 week of arrival, working all of the twelve steps, becoming a participating member of a home group, actively making 9th step amends between months 3 and 6, volunteering and maintaining service commitments.

  • HOUSE RULES

  • Roots Recovery Houses have limited storage space for each resident. Do not bring more than one carry-on sized suitcase and one backpack worth of personal belongings. Residents who arrive with more than the allowed amount of belongings will need to make immediate arrangements to transport any excess off the premises.

    Cell phones, laptops, cars, dating, and social media are privileges that must be earned. Failure to uphold the Roots Recovery Houses Standards may result in the loss of these privileges at any time, regardless of the resident’s length of time in the program.

    Residents are not permitted to attend school. They must focus completely on the work of recovery.

    Cell phone usage is restricted for a minimum of thirty days and is contingent upon regular employment. This restriction will be lifted at the discretion of the house manager based on the resident’s progress and may last longer than 30 days.

    No library or computer usage for a minimum of 30 days except supervised employment search. This restriction will be lifted at the discretion of the house manager based on the resident’s progress and may last longer than 30 days.

    No romantic contact including Facebook, phone, notes, etc. until you have been in the house a minimum of 60 days. This restriction will be lifted at the discretion of the house manager based on the resident’s progress and may last longer than 60 days.

    No car for a minimum of 60 days. This restriction will be lifted at the discretion of the house manager based on the resident’s progress and may last longer than 60 days.

    Follow any and all other rules as updated by staff.

    Complete individually assigned chores at designated times.

    Proper personal hygiene is mandatory.

    Proper clothing must be worn at all times and will be determined by staff.

    No new tattoos or piercings.

    No pornography of any kind.

    No physical altercations.

    Noise levels will be kept to a reasonable level determined by staff. No instruments or music after 10:00 p.m.

    Curfew is 11:00 p.m. Sunday through Thursday and 12:00 a.m. Friday and Saturday.

    Be respectful of our neighbors.

    Refusal to complete any drug screening is cause for expulsion.

    All residents must attend the house meeting nightly Monday through Friday.

    Roots Recovery community residents must pay their own way after the first month. All residents must find a job and work a minimum of 30 hours per week.

    Fees are $125.00 per week, if you are not paid weekly we will make the necessary adjustments.

    Family may pay only the initial admission fee of $700.00. No additional financial support or aid from anyone is permitted during your stay at Roots Recovery Houses.

    Paid “side-work” (yard work, painting, etc.) is only permitted for residents who already have regular employment. Commissioned jobs are not permitted.

    Residents may not work on Sundays. We attend many weekend events, and if you are scheduled to work Saturdays you must get the day off from work. Attendance at these events is mandatory.

    Groceries are not included, residents will be provided with four $50.00 grocery cards for the first month, after that they will pay for their own food.

    Failure to fully disclose any prescription medication, or the use of any prescribed medication not in accordance with the stated directions is grounds for immediate expulsion.

    All personal items must be removed from the premises within 24 hours of completing your stay at Roots Recovery Houses LLC.

  • By signing below I state that I understand that failure to uphold any and all of these standards may result in expulsion from the program and forfeiture of all fees paid to Roots Recovery Houses LLC.

  • INSURANCE INFORMATION AND DISCLOSURE

  • Many residents choose to seek medical, therapeutic or other services covered by health insurance while enrolled in the Roots Recovery Houses sober living program. Please provide insurance information so that we can assist the applicant if they choose to seek or have need for medical or psychiatric help while living at Roots Recovery Houses.

  • Street Address
  • Address Line 2
  • City
  • State / Province / Region
  • ZIP / Postal Code
  • By signing below I, (Insured Named Below), agree that the above information is correct and valid to the best of my knowledge and hereby give Roots Recovery Houses permission to provide this information to any and all health care providers in the event that the resident is attempting to obtain services or where services have been rendered.

  • INSURANCE INFORMATION AND DISCLOSURE

  • By signing below I agree that I have read and fully understand all of the above information. I assert that I have read and understand all admissions requirements, house standards, drug testing policies, housing fees and non- refundable fee information. I affirm that all information supplied by myself is true and accurate to the best of my knowledge.

    I understand that Roots Recovery Houses LLC is not responsible for relapse. I understand that Roots Recovery Houses LLC is not a treatment center and does not have 24 hour staffing, counseling, or medical staff. I understand that Roots Recovery Houses LLC methods are not guaranteed, and that relapse is a common outcome in which Roots Recovery Houses LLC is not to be held responsible.

    I agree that any and all personal belongings left on Roots Recovery Houses premises for more than 24 hours after a resident is discharged or decides to leave the program for any reason become property of Roots Recovery Houses LLC, and by signing below I agree that Roots Recovery Houses LLC has the right to dispose of said belongings in any way they see fit.

    I also agree that I will not hold Roots Recovery Houses LLC legally, morally, financially, or in any other form responsible for anything that occurs while taking part in the program, or anything that happens to any resident or is done by any resident at any time for any reason. I understand that Roots Recovery Houses LLC is not responsible for lost or stolen property.

    I agree that any and all payments made in any fashion by anyone listed on this application or for anyone listed on this application to Roots Recovery Houses LLC are 100% non-refundable.

    I understand that Roots Recovery Houses LLC reserves the right to ask any resident to leave at any time for any reason with or without just cause. I understand that residents will not be under total supervision and that residents will never be restricted from leaving the facility.

    I understand and agree that Roots Recovery Houses LLC and anyone affiliated with them at the time of incident, employed or not employed by Roots Recovery Houses LLC, is not responsible for any injury, death, or harm done to any resident or by any resident. I agree and understand that Roots Recovery Houses LLC is not a treatment center or a facility that is licensed by any state to provide therapy or treatment to residents for any reason. Roots Recovery Houses LLC is a community-based sober living program.

  • The applicant for residency at Roots Recovery Houses hereby warrants the truthfulness of the information provided in this application.