ALCOHOL AND DRUG
TREATMENT PROGRAM ADMISSION AGREEMENT

PLEASE READ THIS DOCUMENT VERY CAREFULLY! TAKE YOUR TIME BECAUSE IT IS VERY IMPORTANT! IF YOU HAVE ANY QUESTIONS, PLEASE FEEL FREE TO ASK QUESTIONS NOW.

I. CACHE CREEK LODGE, A NON-PROFIT ORGANIZATION, LICENSED AND CERTIFIED BY THE STATE OF CALIFORNIA, IS A SOCIAL MODEL TREATMENT FACILITY. THE CACHE CREEK LODGE PROGRAM PROVIDES TEMPORARY RESIDENCE AND TREATMENT FOR PERSONS SUFFERING FROM ALCOHOL AND DRUG ADDICTION. CACHE CREEK LODGE DOES NOT DISCRIMINATE ON THE BASIS OF RACE, NATIONAL ORIGIN, MARITAL STATUS OR SEXUAL PREFERENCE. ACCORDING TO THE STATE OF CALIFORNIA, THE AGE LIMIT IS 18 YEARS OF AGE OR OLDER, OR AN EMANCIPATED MINOR.

II. CACHE CREEK LODGE WILL PROVIDE THE FOLLOWING SERVICES:

A )LODGING, MEALS AND SNACKS.
B) LAUNDRY FACILITIES.
C) LINENS AS REQUIRED.
D )MONITORING OF RESIDENT'S PROGRESS IN RECOVERY.
E) MONITORING OF SELF-ADMINISTERED MEDICATIONS AS DIRECTED BY A PHYSICIAN. THE USE OF SEDATIVES IS PROHIBITED. MEDICATIONS WILL BE RETAINED BY OUR STAFF AND OFFERED AS PRESCRIBED.
F) MEDICAL REFERRALS AS NEEDED.
G) OUR PROGRAM INCLUDES EDUCATION, GROUP PROCESS, A.A./N.A. MEETINGS, INDIVIDUAL COUNSELING, RECREATION, EXIT PLANNING AND A MANDATORY AFTERCARE AND FAMILY PROGRAM.

III.OUR FEE IS $2,100.00 PER MONTH ($70.00 PER DAY.) CACHE CREEK LODGE OFFERS SOME BEDS ON A SLIDING SCALE BASED ON INCOME AND AVAILABILITY OF COUNTY FUNDING. ALL FINANCIAL ARRANGEMENTS MUST BE MADE AND AGREED UPON PRIOR TO ADMISSION.

IV.NO REFUNDS WILL BE GRANTED FOR THE FIRST THIRTY (30) DAYS OF RESIDENCY.AFTER 30 DAYS, THE CLIENT MAY APPLY FOR A REFUND IN WRITING. IF THE CLIENT LEAVES AT THEIR REQUEST, REFUNDS WILL BE MADE AT THE DISCRETION OF THE DIRECTOR. A $250 PROCESSING FEE WILL BE LEVIED.

V.RESIDENTS WILL BE SUBJECT TO TERMINATION FOR THE FOLLOWING:

A)POSSESSION OR USE OF ALCOHOL AND/OR OTHER DRUGS, WHETHER ON OR OFF SITE. LIFE SUSTAINING MEDICATIONS AND CORRECTLY PRESCRIBED DOSAGES OF MEDICINES SELF-ADMINISTERED ARE ACCEPTABLE WITH STAFF APPROVAL.

B)SEX OR SEXUALLY INAPPROPRIATE BEHAVIOR WITH RESIDENTS, CLIENTS, BOARD MEMBERS, VOLUNTEERS, STAFF, OR ANY OTHER MEMBERS OF THE CACHE CREEK LODGE PROGRAMS.

C)VIOLENT OR THREATENING BEHAVIOR (INCLUDES PHYSICAL, VERBAL, NONVERBAL, EMOTIONAL, PSYCHOLOGICAL, ETC.)

D)FAILURE TO PARTICIPATE IN PROGRAM ACTIVITIES, INCLUDING GROUPS, CHORES, RECREATION, MEALS, COMMUNITY SERVICE, 12 STEP MEETING ATTENDANCE, STAFF DIRECTIVES, RESTRICTIONS, ETC.

E)SEXUAL HARASSMENT OR INAPPROPRIATE BEHAVIOR TOWARDS CLIENTS, STAFF AND OR VISITORS. INAPPROPRIATE BEHAVIOR IS ANYTHING THE STAFF DEEMS SOCIALLY UNACCEPTABLE. YOU WILL RECEIVE ONE WARNING.

F)RELATIONSHIP BUILDING I.E., SPENDING TOO MUCH TIME WITH ONE INDIVIDUAL ON OR OFF THE PREMISES.

G)INAPPROPRIATE TOUCHING.

H)FALSIFYING PAPERWORK, INCLUDING PASSES.

I)NON-COMPLIANCE WITH TREATMENT PLAN, FAILURE TO MAKE PROGRESS TOWARDS GOALS.

NOTES:A CLIENT TERMINATED FOR ANY ONE OR MORE OF THE ABOVE REASONS MAY BE CONSIDERED FOR READMISSION AFTER TWO WEEKS.

THE FIRST TWO WEEKS OF RESIDENCY IS A PROBATIONARY AND EVALUATION PERIOD. AT ANY TIME DURING THESE TWO WEEKS, A CLIENT MAY BE DISCHARGED IF THEY ARE FOUND TO INAPPROPRIATE FOR OUR PROGRAM.

VI.HAVING VOLUNTARILY ENTERED CACHE CREEK LODGE, REGARDLESS OF THE REFERRAL SOURCE THAT BRINGS ME HERE, I COMMIT MYSELF TO THE FOLLOWING:

A)OBSERVE ALL PROGRAM RULES, REGULATIONS AND DIRECTIVES.

B)USE NO SEDATIVES, TRANQUILIZERS, ALCOHOL, OR DRUGS. DO NOT BRING MEDICATIONS, SPECIAL FOODS, OR BEVERAGES INTO THE FACILITY WITHOUT THE KNOWLEDGE AND APPROVAL OF THE STAFF. I UNDERSTAND THAT MEDICATION PRESCRIBED WILL BE RETAINED AND MONITORED BY STAFF.

C)PARTICIPATION IN ALL ASPECTS OF THE PROGRAM WHICH INCLUDES GROUPS, INDIVIDUAL COUNSELING, CHORES, A.A./N.A. MEETINGS, WORK ASSIGNMENTS, ORIENTATIONS AND EXERCISE.

D)PERMIT DRUG AND ALCOHOL TESTING IN ANY FORM AS REQUIRED BY STAFF.

E)MAKE CACHE CREEK LODGE MY PRIMARY FINANCIAL OBLIGATION. ALL OTHER OBLIGATIONS WILL RECEIVE SECONDARY CONSIDERATION.

F)HOLD CACHE CREEK LODGE, ITS AGENTS, MEMBERS AND EMPLOYEES FREE FROM ALL LIABILITY FOR ALL PERSONAL INJURY OR LOSES THROUGH FIRE OR THEFT WHILE I AM ABOUT THE PREMISES OF SAME. THAT AFTER LEAVING CACHE CREEK LODGE, I GIVE TRANSFER OR ASSIGN ALL PERSONAL PROPERTY LEFT ON THE PREMISES IN CLEAR TITLE TO CACHE CREEK LODGE AFTER FOURTEEN (14) DAYS.

G)IF, DURING THE TIME THAT I AM A RESIDENT OF CACHE CREEK LODGE, A MEDICAL EMERGENCY SHOULD OCCUR AND IT IS IN MY BEST INTEREST TO BE HOSPITALIZED, I HEREBY CONSENT TO SUCH TEMPORARY HOSPITALIZATION.

H)I HAVE RECEIVED A COPY OF MY PERSONAL RIGHTS AND A COPY OF THIS AGREEMENT.

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