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  • HH Recovery Application

  • APPLICANT INFORMATION

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  • EMERGENCY CONTACT INFORMATION

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  • PROGRAM OFFERINGS:
    As of March 1, 2025 Hope House is offering two programs – a 6-month and a one-year program. (see Policies and Procedures for details). Effective March 1, 2025, the program fee for residents is $500.00 per month (non-refundable) to offset the costs of food, shelter, supervision, and other operating expenses. Hope House does not accept insurance.


    6-Month Program
    This program is available for approved residents who agree to pay for their 6-month residency. There are no scholarships available. Prior to entry, residents must pay non-refundable $1,000.00 deposit (first and last month program fees). They must pay $500.00 per month (non-refundable) due on the first of  the month.


    1-Year Program
    Scholarships may be available on a case-by-case basis for residents who are unable to pay the $500.00 per month fee. Scholarship decisions will be made by the Program Director.

  • BACKGROUND

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  • SUBSTANCE ABUSE HISTORY

  • MEDICAL HISTORY

  • PHYSICAL HEALTH INFORMATION

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  • WORK/SKILL HISTORY ASSESSMENT

  • FUTURE ASSESSMENT

  • List all individuals that may be interested in supporting your stay (emotionally, financially) at Hope House.

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  • RESOURCES

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  • If YES, provide below information:

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  • PROGRAM CONDITIONS:

  • I affirm that all information in this application is true and correct and that no effort has been made to deceive, hide, or neglect the transmittal of any information that is vital to the application process.

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  • RELEASE OF INFORMATION

    I give consent for the Program Director of Hope House or designee to release information about me or any member of my family to any organization that may have the ability to assist me in my current situation.  Organizations include but are not limited to health care providers, health care facilities, parole or probation officer, workforce solutions, family crisis centers, MHMR, Department of Human Services, law enforcement, children’s advocacy center, CARTS and help assistance programs.  I also give my consent for the organizations to release information to the Program Director of Hope House or designee. This release of information is for the above organizations and any other organization the Director may contact.

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  • MEDICAL TREATMENT, INFORMATION, AND RELEASE

    In case of medical emergency, I hereby give consent to Hope House and/or their directors, officers, employees, representatives, and their agents to contact 911 and/or any medical professional on my behalf.  I understand that I am responsible for any and all financial responsibilities that may occur. I understand that I should use my permanent address, not the Hope House address, on my medical claim forms.

    I authorize Hope House to obtain and release my medical records. I also authorize my medical records to be released from my medical provider, hospital, clinic, doctor’s office or its staff to Bastrop Hope House.

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  • Property Retrieval

    All residents who are removed or who exit from the Hope House program have 7 days from the date of discharge to schedule an appointment to retrieve personal property.

    My signature acknowledges that in the event I am exited/removed, if I do not schedule an appointment AND retrieve my property within 7 days of my discharge date, the belongings will become the property of Hope House to keep and/or discard as appropriate.

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  • HOPE HOUSE ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

    I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN HOPE HOUSE’s residential housing program, including any risks that may arise.  I certify that I am physically/mentally fit and have not been advised to not participate by a qualified medical professional. I certify that there are no health related reasons or problems which preclude my participation in this program and its activities.  I acknowledge that this “Accident Waiver and Release of Liability Form” will be used by Hope House, and that it will govern my actions and responsibilities while a participant of the program. 

    In consideration of my application/enrollment and permitting me to participate in this program, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including traveling to and from activities/events of this program, THE FOLLOWING ENTITIES OR PERSONS: Hope House, HOG Christian Ministries, The Gathering, and/or their directors, officers, employees, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers; (B)I INDEMNIFY, HOLD HARMLESS AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in any program event/activity, whether caused by negligence of release or otherwise.  I acknowledge that Hope House, HOG Christian Ministries, and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors or omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Hope House. Risks may include, but not limited to, those caused by fundraising/production, work, terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people.

    I understand that Hope House staff is not licensed or insured or professional medical staff; this is a pastoral ministry with assigned staff and volunteers. I hereby consent to receive medical treatment by a licensed provider in the event of injury, accident, and/or illness. I understand that any medical expenses incurred are my personal responsibility regardless if I have insurance; I agree to hold Hope House harmless from any liability for medical expenses incurred as a result of my residency.  I understand that as part of this program, I may be photographed.  I agree to allow my photo, video, film likeness and approved testimony to be used for any legitimate purpose by the program or designee.

    The accident waiver and release of liability shall be construed broadly to provide release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT.  I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

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  • BACKGROUND INVESTIGATION CONSENT FORM

    I hereby authorize Hope House and/or its agents to make an independent investigation of my background, references, character, past employment, education, criminal, or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained in my application and/or obtaining information, which may be material to my qualifications for residency, now and if applicable, during my tenure at Hope House.

    I release Hope House and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or law suits in regards to the information obtained from any and all of the above referenced sources used.

    The following is my true and complete legal name, and all information is true and correct to the best of my knowledge:

  • List all addresses of places you have lived the past 7 years and the years you lived there.

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