By clicking the “Submit” button on the application page, you agree that you have read and understand the following statements, and will abide by them. If you do not agree with these statements, we cannot accept your application.

  1. I will be tested as soon as possible for TB, HIV, and Hepatitis A, B, and C and will have the results forwarded to the intake counselor at Victory Home. I understand that a reactive or positive result from the lab work may disqualify me from admission.
  2. I understand that my application will not be reviewed by the application committee or be put on the waiting list until Victory Home has received my completed application, lab work, application fee, and rap sheet. I will call Victory Home to confirm the status of my application three days after it has been mailed in.
  3. I understand that the approval of my application is contingent upon all court dates and hearings either to be resolved or postponed until I leave Victory Home. I understand that if I have to go to court while at Victory Home, I will be dismissed from the program and must re-apply for re-admittance.
  4. I understand that Victory Home does not subscribe to the concept of addressing chemical dependence problems with psychotropic medications. Victory Home is not a medical facility nor can it properly monitor a psychotropic regimen. Current prescribed medications that are non-psychotropic and nonnarcotic will be considered and if I am accepted with my current medications, I will take them as prescribed. I understand that, although my medications will be secured in the office, Victory Home will not accept responsibility for dispensing my medications to me. I also understand that If I have been taking any narcotic medications, I must submit a letter from my physician indicating that I have been properly weaned from that medication prior to my anticipated intake date.
  5. I understand that I must be 21 years old or older and sober from drugs/alcohol for at least 72 hours prior to my intake date. I also understand that during my intake interview, I will be screened to determine whether I have been sober for at least 72 hours.
  6. I understand that if I am approved and scheduled for an intake interview date, I will be on time and prepared to stay.
  7. By submitting my application, I indicate that I am coming on my own free will. I hereby agree to cooperate in the work program and abide by all rules. I also agree to submit to random urinalysis or random saliva test for determination of a drug/alcohol free lifestyle while at Victory Home. I also agree that any saliva/urine tests performed will be taken out of my Medial Deposit.
  8. I do assume risks that might be incidental to my stay; and I do hereby for heirs, executors, and my administrators, myself, or any representatives, release and relinquish forever, any and all claims of any nature whatsoever that may arise out of or in connection with my stay here. I also give Victory Home permission to release information/records as the occasion arises.