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LIFELINX HOUSING POLICIES & RULES
OCCUPANCY
RESIDENTS MAY TAKE UP RESIDENCY ONLY AFTER ALL DEPOSITS, AND FEES ARE PAID. BEDS ARE FILLED
ON A FIRST COME FIRST SERVED BASIS. TWO WEEKS NOTICE IS EXPECTED PRIOR TO LEAVING. RESIDENTS WHO LEAVE
WITHOUT GIVING TWO WEEKS NOTICE (INCLUDING THOSE WHO RELAPSE, SMOKE IN THE BUILDING, ETC.) WILL BE
EXPECTED FORFEIT THEIR SOBER DEPOSIT.
FEES
THE FEE IS $154. PER WEEK. THE WEEK RUNS FROM SATURDAY THROUGH FRIDAY. IF YOU COME TO LIFELINX ON
A DAY OTHER THAN SATURDAY, WE WILL MAKE THE NECESSARY ADJUSTMENT. THE AMOUNT TO ENTER LIFELINX IS $537...
(INCLUDES THE FIRST TWO WEEKS FEES ($308.) AND A SOBER DEPOSIT OF $154 PLUS. $75. FOR LINENS WHICH WILL BE
OWNED BY THE RESIDENT.).
FIRST 160
SECOND 160
SEC DEP 160
LINENS 75
555
+ 22 PER DAY OCC ADJ (FOR STARTUP OTHER THAN SATURDAY)
3.
ALCOHOL & DRUGS
POSSESSION OR CONSUMPTION OF ALCOHOL OR ILLEGAL DRUGS IS CONSIDERED A RELAPSE AND
WILL BE CAUSE FOR REMOVAL. NO ALCOHOL, DRUGS, DRUG PARAPHERNALIA, FIREARMS, OR OTHER WEAPONS ALLOWED
ON THE PREMISES. ALL PRESCRIPTION DRUGS MUST BE LISTED WITH MANAGER (SEE ATTACHED PRESCRIPTION LIST).
MISUSE OF PRESCRIPTION DRUGS WILL BE CONSIDERED A RELAPSE. IF YOU KNOW OR EVEN SUSPECT THAT ANOTHER
RESIDENT IS USING OR DRINKING, IT IS YOUR OBLIGATION TO TELL MANAGEMENT. FAILURE TO DO SO WILL MAKE YOU
COMPLICIT IN THEIR RELAPSE AND MAY BE DEEMED CAUSE FOR REMOVAL. RANDOM DRUG AND ALCOHOL TESTS WILL BE
GIVEN. STAYING OUT BEYOND CURFEW OR NOT RETURNING AS PLANNED ON AN OVERNIGHT MAY BE CONSTRUED AS A
RELAPSE.
4.
SMOKING
NO SMOKING IN THE BUILDING INCLUDING BATHROOMS, BASEMENT, ETC. ANYONE CAUGHT SMOKING IN THE
BUILDING WILL BE REMOVED FROM THE PREMISES IMMEDIATELY. SEE # 1 FOR SEC & RENT FORFEITURE.
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CURFEW
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PROBATION
PEOPLE JUST ENTERING LIFELINX LODGE ARE ON PROBATION FOR 30 DAYS. OCCASIONALLY A RESIDENT
MAY BE PUT BACK ON PROBATION AFTER HE OR SHE HAS BEEN WITH US FOR A WHILE. DURING PROBATION NO OVERNIGHT
PASSES ARE GRANTED, THE CURFEW IS I HOUR EARLIER THAN NORMAL CURFEW. YOU ARE REQUIRED TO ATTEND 30
MEETINGS IN 30 DAYS. (WE STRONGLY SUGGEST 90 IN 90). DURING YOUR 30 DAY PROBATION PERIOD WE WILL BE
REVIEWING YOUR ATTITUDE, COMPLIANCE WITH RULES, ABILITY TO GET ALONG, ETC. TOWARD THE END OF YOUR
PROBATION PERIOD WE WILL MAKE A DECISION TO INVITE YOU TO REMAIN WITH LIFELINX OR TO LEAVE. EVERYONE ON
PROBATION WILL BE ASKED TO SIGN A CONTRACT OF UNDERSTANDING.
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MEETINGS WE HAVE A MANDATORY HOUSE MEETING ONCE EACH WEEK ON ____________ AT __________PM. NO EXCUSES.
LIFELINX LODGE RESIDENTS ARE ALSO REQUIRED TO ATTEND AT LEAST FIVE 12 STEP MEETINGS PER WEEK (ALTERNATIVE
PLANS MAY BE APPROVED IN WRITING BY MANAGEMENT).
8.
OVERNIGHT STAYS OVERNIGHT STAYS OFF PREMISES MAY BE APPROVED AFTER THE FIRST 30 DAYS OF RESIDENCY. ALL
PASS REQUESTS AND APPROVALS MUST BE IN WRITING. TO RECEIVE A SIGNED OVERNIGHT PASS, FEES MUST BE CURRENT
THROUGH PERIOD OF PASS, ROOM MUST BE NEAT WITH BED MADE, AND CHORES MUST BE COMPLETE AND/OR SIGNED
FOR.. NO PASSES WHILE ON PROBATION.
9.
ROOMS
IN BUILDINGS WHERE DOORS ARE LOCKED, RESIDENTS MAY LOCK DOORS TO THEIR ROOMS WITH KEYS
PROVIDED BY MANAGEMENT. MANAGEMENT RESERVES THE RIGHT TO INSPECT ROOMS AND PERSONAL BELONGINGS.
RESIDENTS ARE ALLOWED IN ANOTHER’S ROOM ONLY WITH THAT PERSON PRESENT. GUESTS MUST BE OFF THE PREMISES
BY ONE HOUR PRIOR TO CURFEW TIME UNLESS OTHER PERMISSION IS OBTAINED FROM MGMT. YOU ARE NOT ALLOWED TO
KEEP FOOD IN YOUR ROOM. FOOD, COOKING DEVICES, COFFEE POTS, HOT PLATES, MICROWAVES, REFRIGERATORS, ARE
NOT ALLOWED IN ROOMS. FURNITURE AND FURNISHINGS OWNED BY LIFELINX OR TRANSFERRED TO THE RESIDENT BY
LIFELINX SHALL NOT BE REMOVED FROM ROOMS (OTHER THAN CLEANING OF LINENS, ETC.) WITHOUT PERMISSION OF
MANAGEMENT. PLEASE REFRAIN FROM BRINGING IN PERSONAL FURNITURE, LINENS, ETC. WITHOUT WRITTEN PERMISSION
FROM THE MANAGER.
10.
PHONE CALLS ARE LIMITED TO 8 MINUTES. PLEASE ENTER ALL MESSAGES IN BOOK AND PLACE MESSAGES IN APPROPRIATE MAIL BOX.
11.
EMPLOYMENT PLEASE CHECK WITH THE MANAGER REGARDING EMPLOYMENT. PLEASE DO NOT ACCEPT EMPLOYMENT THAT WILL PUT
YOUR RECOVERY AT RISK. FIRST SHIFT HOURS ONLY!
12.
CHORES EACH RESIDENT IS REQUIRED TO COMPLETE AN ASSIGNED CHORE
13.
MEALS AT RESIDENCES WHERE MEALS ARE INCLUDED, RESIDENTS MUST PAY AN ADDITIONAL $49.00 PER WEEK IN ADVANCE FOR
MEALS. DINNER IS SERVED AT 6:00 PM SEVEN DAYS PER WEEK.
IS __________ MON – THR AND _______ ON FRI, SAT AND NIGHT BEFORE HOLIDAYS IF NOT ON PROBATION.
I HAVE READ AND I ACCEPT THE RULES ABOVE __________________________________________________
Applicant Signature
LIFELINX HOUSING, 2785 BOSTON POST RD, GUILFORD, CT 06437
__________
Date
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203-208-2228
fax 203-208-2221
Application
Date______________
Name __________________________________ Sex: ___ Age: ____ DoB: ________________ Soc.Sec. #
Current Program ______________________ Phone
Counselor
Discharge Date
When will you be available to enter Lifelinx? ______________Details
Residence Prior to Treatment
Current Employer ____________________________Address _____________________City _____________ST ____ZIP
Employer Phone _____________________
Referred to Lifelinx by:
Marital Status: M/S/D/S/W Name, & Phone # of Person to Call in Emergency
Are you in a relationship now?
Is the person in recovery?
How much clean time do they have?_________
Insurance
Medical insurance, if any: _______________________Do you have SAGA?
, T-19
, SSDI
#
Phone Number for Insurance Clearance _________________________________________________________________________________
Treatment Programs Approximate Dates
Program
City
Length of Stay
_______________
______________________________
_____________________
____________
_______________
______________________________
_____________________
____________
_______________
______________________________
_____________________
____________
_______________
______________________________
_____________________
____________
_______________
______________________________
_____________________
____________
Substances Used:
______________________________________________________________________________________________________________________
Sobriety Date: ____________ Do you smoke? Y  N  How much? __________ Are you on methadone maintenance now? Y  N 
Legal problems (current & past): Include all Charges, Outstanding Warrants, Convictions, Jail Time, and Probation. Please
include all prior and current charges. We know that many of us have had problems in the past. This information will not
necessarily prevent admission to Lifelinx. Your honesty is important to us.
Approximate Date
Charge
State
Status
Convictions or Pending
_______________
________________
____
_______________
____________________
_______________
________________
____
_______________
____________________
_______________
________________
____
_______________
____________________
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________________
____
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Probation / Jail
Are you on probation now? Y__ N__ County_______________ PO Name__________________ Completion Date
Do you have any open warrants? Y ___ N___ Stipulated meetings, Participation Requirements, or Court Ordered Community Service:
Have you ever been convicted of a sex crime, arson, or any crimes involving violence? Y

N
Please provide details. Use extra
sheet if needed. Problems......Marital, Custody, Child Support, etc. or Situations
Do You Have a Driver’s License # ____________________ Driver’s Lic. ST ___ Current Status of Driver’s Lic: Valid / Susp / Other
DMV Violations (last 3 years only) __________________
________________
Do you plan to have a vehicle at the premises? Y__ N__
Vehicle Yr ______ ST ____ Make _______ Color ____ Reg #______________Insured by: __________________________________
Are you now or have you been in the past seven years party (on either side) to a lawsuit? Y □ N □
If yes explain:
_________________________________________________________________________________________________
________________________________________________________________________________________________
CONFIDENTIAL MEDICAL CONDITIONS & PRESCRIPTION DETAILS
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RESIDENT NAME ______________________________OCC DATE_____________ ROOM #_________BED #_______
List Last Updated___________ List Last Updated___________ List Last Updated___________ List Last Updated_________________
Medical, Psych and Emotional Conditions & Diagnosis. List all current diagnoses, DR’s, meds, & Pharmacies
Condition or Diagnosis (include allergies) Doctor
Prescription
Dosage
Pharmacy
(include allergies)
__________________________ _________________ __________________ _________________
__________________________ _________________ __________________ _________________
__________________________ _________________ __________________ _________________
__________________________ _________________ __________________ _________________
If accepted into Lifelinx Lodge, Applicant agrees to provide Manager of Lodge with a current list of all prescriptions as shown above.
Applicant further agrees to keep Manager informed of any updates, renewals, or changes to the prescription list as shown above.
Resident agrees to keep this list current. Resident agrees not to have duplicate prescriptions and to provide Manager of
Lodge with a current list of all prescriptions. Residents are required to keep this list current and up to date.
PPD TEST
__________________________________
Optional Only: Other information you think we should know? (Problems, hobbies, special interests, special skills, aptitudes,
preferences, talents, behaviors, allergies, beliefs, restrictions, special needs, likes, dislikes, etc.)
____________________________________________________________________________________________________________
I understand that Lifelinx Lodge is not responsible for theft or loss of personal possessions. Rental rates are per week and rent is due on
Saturday morning. Tenants are required to give two weeks notice prior to leaving.
The security deposit less any damages will be returned at the end of the occupancy term as long as I have not relapsed or smoked in
the building and I have given Lifelinx two week’s notice. My first payment must be received prior to move in. The applicant agrees that if
any default be made in the performance of any agreement contained herein, the boarding house owner may re-enter and take
possession of the room or room section as provided by laws of the State of Connecticut, USA. The boarding house owner shall have
the right to enter the room at reasonable hours, for the purpose of examining same, assuring a drug free environment, or making such
repairs or alterations as may be necessary for the safety and preservation thereof.
Lifelinx Corporation provides beds, furniture, cookware, silverware, dishware, cleaning materials, refrigerator, stove, furniture, utilities,
and a telephone for local calls. Lodger shall provide towels and personal items. Linens are provided to resident for a fee of $75. Upon
termination of the lodging arrangement, Lodger shall return space in same condition as it was in when he took occupancy. Assuming
Lodger has stayed clean and sober, has not smoked in the building, and has been compliant with the rules; Lifelinx shall return the
security deposit to the lodger after deduction for any rental payments due, or any damages suffered by the boarding house owner by
reason of the lodger’s failure to comply with his obligations pursuant to this agreement.
In order to secure faithful performance of the obligations pursuant to this agreement, the boarding house owner shall have a statutory
lien on the personal property of the lodger in accordance with Connecticut General Statutes 49 - 68. Should you leave or relapse you
have three (3) days to remove your personal belongings or management may dispose of them.
The applicant agrees that he (she) will change their residence address with the US Post Office, and if applicable The CT DMV when
they complete their stay at Lifelinx Lodge. It is understood that lodger’s security deposit may be withheld if this is not complied with. The
attached blank sheet is provided to enable you to make your responses as complete as possible. Lifelinx Lodge does not discriminate
because of Race, Color, Religious Belief, Age, or Sexual Orientation.
If you are in a program or hospital now, please have your counselor provide you with a standard release in favor of Llifelinx
Lodge and the applicable institution.
___________________________________________
Applicant’s Signature
______________________________________
Host / Manager, Lifelinx Lodge
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