Admissions

Men's Residence

New London CT

Women's Residence

New London CT

Please download the application form and release of information form by clicking the buttons below. Please print, fill out, and email both forms to info@ctrecoveryhouse.com or fax to 860-471-8141.

If unable to download the forms, fill out the contact form below with your details and we will get back to you.

Applying For

Raymond House: Men’s Residence, New London CT Berkeley House: Women’s Residence, New London CT

Name

Phone

Additional Information

Service Fees and Refund Policy

I have read and understood the below Service Fees and Refund Policy:
❑ Administrative Fee: $150.00 required prior to move-in (one-time, non-refundable fee to cover administrative costs)
❑ Single Occupancy Room: $165.00/week or $725.00/month
❑ Multiple Occupancy Room: $155.00/week or $675.00/month

I understand that if I prepay any fees to Connecticut Recovery House for admission and opt not to come, I will not be eligible for any refund of fees, rather any pre-paid fees will be converted into a credit good for services at Connecticut Recovery House for up to 1-year from date paid. I understand that if I am a Guest of Connecticut Recovery House and I am discharged for administrative reasons (failure to comply with rules and guidelines) that I forfeit any prepaid service fees and am not eligible for a refund. Guests of Connecticut Recovery House in good standing may request a refund of pre-paid service fees with 2-weeks’ notice.

I realize that the Recovery House to which I am applying for residency has been established in compliance with the conditions of §2036 of the Federal Anti-Drug Abuse Act of 1988, P.L. 100-690, as amended, and requires the Guests of the residence to remain abstinent from drugs and alcohol. I realize that I can be discharged from the house that I become a member of, if for some reason I return to using drugs and alcohol and/or if my behavior is such that it compromises the moral integrity of the house. I also realize that at such time that I am expelled; I will have 30 minutes to remove my personal belongings from the house or make arrangements to come back for them. I also realize that if I am hospitalized, my emergency contact will be notified.

I have completed this application and have answered questions honestly and to the best of my ability. I agree that if I am accepted into Connecticut Recovery House, I accept the terms of this application and the terms of the guidelines and policies of Connecticut Recovery House, and I have made a commitment to achieve sobriety and recovery from alcoholism and/or drug addiction without relapse. In accepting these terms, the applicant understands that §2036 conditions are different than the normal due process afforded by some local landlord-tenant laws.

*I understand that typing my name in this application constitutes my digital signature.

Applicant Name (Signature)*

Date