Please enable JavaScript in your browser to complete this form.Layout1. General Conduct Residents must treat others with respect No violence, threats, harassment, or discrimjnation. No illegal activity; noise kept low between 10 PM - 7 AM.3. Visitors & Guests Visiting hours: 9:00 AM - 8:00 PM only. No overnight guests without written approval. Resident is responsible for guest behavior.5. Safety & Security No firearms, weapons, or dangerous items. Do not tamper with safety or security equipment. Keep doors locked; follow emergency procedures.7. Property Damage & Repairs Resident must pay for damages caused by misuse. No unauthorized alterations to property.9. Inspections Provider may perform room inspections with 24-hour notice or immediately in emergencies.2. Cleanliness & Maintenance Keep room clean and sanitary. Shared areas must be cleaned after use. Do not block hallways or emergency exits.4. Substance & Medication Policy No illegal drugs or excessive alcohol use. Medication must be self-managed. Smoking allowed only in designated areas.6. Personal Responsibility Maintain personal hygiene. No expectations of care, supervision, or transportation. No sharing or selling belongings.8. Prohibited Behavior Violence, threats, illegal drug activity, or repeated rule violations may result in immediate termination.10. Termination of Housing Housing may be terminated for unpaid rent, repeated violations, safety risks, or exceeding independent living capabilities.Resident AcknowledgmentLayoutI,agree to follow all House Rules. LayoutResident Signature: *Clear SignatureDate *LayoutProvider Signature: *Clear SignatureDate *LayoutResident Responsibilities Maintain personal hygiene and living space, follow house rules, pay fees on time, avoid illegal/disruptive behavior.Safety & Emergency Procedures Resident must comply with fire and emergency procedures. No tampering with safety devices or property.Liability Release Resident releases and holds Provider harmless from injuries, illness, or loss except in cases of proven negligence.House Rules A separate House Rules Policy applies and is incorporated into this agreement (Attach as ExhibitA)Termination of Agreement Provider may terminate with_ days notice for non-payment, violations, safety risk, or if care needs exceed independent living. Emergency termination may occur.Acknowledgment of Independent Living Status *Resident confirms they can live independently without assistance.They understand this is a housing-onJy agreement Agreement SignaturesLayoutResident Signature: *Clear SignatureDate *Provider Representative Name *LayoutSignature: *Clear SignatureDate *LayoutTerm of AgreementMove-in Date: *Agreement Type: * Month-to-Month Fixed TermNotice to terminate: *days required by either party.Services Provided Furnished room/bed Access to shared spaces Utilities and property maintenanceServices NOT Provided No services related to health, meal, care, mobility, supervision, or medication.Housing FeesMonthly Housing Fee: *Security Deposit: *Due Date: *Late Fee: *Payment Method: *Submit
