SOBER LIVING PROGRAM APPLICATION

THE ANCHOR @ WOODPOINT PROGRAM APPLICATION

COMPLETE EACH SECTION BELOW:

Full Name, Address, Phone, and Date of Birth:

Email*

Vehicle: Y or N Valid Driver's License Y or N

Emergency Name and Address:

Relationship of Emergency Contact:

Have you ever been convicted of any violent or sexual crimes? Y or N

Probation Office Name, Address & Phone No:(if any)

Current Rehab Program/Facilities & length of stay:

Drug(s) of Choice: (List All in order of Preference)

Any IV Opiate Use: Yes or No

History of Self Harm: Y or N If Yes, What type and dates of Self Harm:

List all medications currently taking:

Are you currently Employed? Y or N If Yes, Name of Employer and length of employment:

If you prefer a PDF Application to be emailed to you, text 301-992-4430 with your email address.

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Live in stress-free setting with a strong recovery community of men in a caring & nurturing setting.

THE ANCHOR @ WOODPOINT is a sober living home located in Hagerstown, Maryland for men only. Live in a fully-furnished deluxe home in a quiet residential setting. Enjoy the amenities of a luxury home that includes your own bed (SHARED ROOM) with bedding & bath linens provided.

Includes on-site washer, dryer, modern kitchen & baths, living rooms w/TV’s, Wi-Fi, computer w/printer, central air and heating.

SOBER HOMES MARYLAND LLC

Hagerstown, MD 21741

301-992-4430

TAKE THE NEXT STEP IN YOUR SOBRIETY

THE ANCHOR @ WOODPOINT PROGRAM APPLICATION

COMPLETE EACH SECTION BELOW:

Live in stress-free setting with a strong recovery community of men in a caring & nurturing setting.

SOBER HOMES MARYLAND LLC