Program Application

If left blank application will not be processed. Please give a real date of expected arrival and/or release.

How will your first month be paid?

List all charges: Also: Please explain in detail any violent charges:

I have completed this application to the best of my ability and answered all questions honestly. I have read all materials provided to me and understand that by signing below, I am agreeing to follow all A&Y Sober and Independent Living house rules and policies. A copy of the House Rules has been provided to me as part of this application. When I am accepted to A&Y Sober and Independent Living, and take residency, I agree to hold harmless A&Y Sober and Independent Living, corporate officers, property owners, independent service contractors, and all service providers from all claims, actions, and liabilities. I authorize A&Y Sober and Independent Living to exchange information as needed with any government or private parties and/or their representatives as it relates to the application process and housing status while living at Rising Sun Sober Living. I understand and agree that all payments to A&Y Sober and Independent Living are non-refundable. Reasonable accommodations for people with disabilities will be provided upon request. I have read both statements above, understand their contents, and voluntarily agree to their terms.

Thank you for choosing A&Y Sober and Independent Living as your housing provider. If you have any questions, feel free to contact us at (619) 782-1949 or write to us. A response letter will be sent within 48 hours of receipt and will provide instructions for “Move-in Day.” We look forward to meeting you soon.