PASS FORM
CONSIDER THIS VERY CAREFULLY BEFORE SUBMITTING A PASS REQUEST. IF A PASS IS SUBMITTED PRIOR TO COMPLETING 60 FULL DAYS OF RESIDENCY WITH YOUR SPONSORS FULL APPROVAL IT IS AUTOMATICALLY DENIED AND WILL NOT BE RECONSIDERED 


All requests must be recorded in advance at your house meeting. You must receive approval on Friday night prior to departure. Passes not submitted 72 hours in advance will be denied. ONLY PHASE THREE RESIDENTS MAY TAKE A PASS BEYOND 4 MONTHS RESIDENCY NO EXCEPTIONS. Approval from your sponsor is required to request a pass. 

A Mandatory Meeting Exemption can also be completed on this form for a Friday night, Tuesday night or Sunday morning absence. 

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Email *
ACKNOWLEDGEMENT:
BY SUBMITTING THIS REQUEST YOU ACKNOWLEDGE THAT THIS PASS REQUIRES A ZERO BALANCE ON RENT AND FULL TIME EMPLOYMENT AT THE TIME OF SUBMISSION AND DEPARTURE.  THAT PASSES MUST INCLUDE REGULAR MEETING ATTENDANCE. FINALLY, I ACKNOWLEDGE THAT A PASS IS GRANTED ONCE PER CALENDAR MONTH. 
TYPE OF REQUEST: *
PHONE NUMBER *
DATE OF REQUEST: *
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DATE OF DEPARTURE FOR PASS OR WORK COMMITMENT: *
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I UNDERSTAND THAT I MAY NEVER DEPART WITHOUT APPROVAL AND A ZERO BALANCE WITHOUT LOSS OF PASS PRIVILEGES. I AGREE THAT I MUST PERSONALLY PAY MY OWN RENT WITHOUT EXCEPTION AND THIRD PARTY PAYMENTS ARE A VIOLATION OF BHR POLICY. I ALSO UNDERSTAND THAT PASSES ARE NOT FOR “SIDE WORK” OFF CAMPUS OR DATING IN EARLY RECOVERY. *
CHECK BOX BELOW TO AGREE THAT YOUR SPONSOR HAS GIVEN HIS APPROVAL:
Required
GIVE A BRIEF DESCRIPTION OF *RECOVERY* PLANS WHILE ON PASS OR REASON FOR EXEMPTION  *
PRINT YOUR NAME IN THE BOX AS AN AGREEMENT. FOR PASSES, YOU MUST HAVE YOUR COMMITMENTS (1) RELEASED ON CALENDAR AND (2) POSTED ON SLACK (3) MEETING REQUIREMENTS MET (4) SPONSOR APPROVAL THEN REPORT IMMEDIATELY UPON RETURN IN ORDER TO HAVE A URINE ANALYSIS. SUBMITTING A PASS WITHOUT SPONSOR PERMISSION WILL RESULT IN THE LOSS OF ALL PRIVILEGES *
A copy of your responses will be emailed to the address you provided.
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