Freedom House Individual Application
John 8:32 Know the truth and the truth will set you free!

We focus on a whole person treatment model. We help individuals with life controlling blockages to success.


Thanks for checking out Freedom House. This is a ministry where individuals can find hope for their future. We take seriously our commitment to address the needs of each individual and to assist them in the development of character. We dedicate ourselves mentor and to nurture meaningful relationships and family.

Please read these informational pages completely before moving to fill out the Family application and medical history forms. This will help insure a successful application process with fewer “surprises” for all parties involved.

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Important Information:
MUST READ BEFORE CONTINUING APPLICATION
Freedom House does not operate as a medical model program and as such does not have attending physicians or staff who are able to prescribe and monitor medications. Individuals who are prescribed medications will need to 1) make certain all medications taken are on the approved list of medications, and 2) arrange connections with local physicians for the purpose of continuous monitoring of prescribed medications. Individuals who are prescribed narcotics are not eligible for enrollment. 
Distribution of all medications including vitamins, aspirins, or cold remedies will be handled by the Freedom House mentor(s) in accordance with policies and directions indicated on each prescription and/or manufacture. Any medications brought into the program must be purchased in the presence of the mentor(s).

The Freedom House mentor(s) or verified as the drug prescribed by the physician. Expenses for an individual's medications are to be covered by the individual. Individuals must exhibit and possess emotional and mental stability, which enables them to participate successfully in group living situations.

**Legal Issues**
As with medical issues, potential participants need to have all known and necessary legal issues and other program requirements. This includes court hearings, sentencing, criminal and misdemeanor charges, warrants or arrest, jail time, involvement with attorneys, and law enforcement agencies. All legal expenses incurred by an individual, including transportation, meals, lodging, supervision, etc. shall be the responsibility of that individual.

Freedom House and its parent agency will cooperate with outside law enforcement agencies, courts, parole and probation departments, attorneys, immigration,etc., by providing information, progress reports, and other written documentation required while the individual attends the Freedom House.

**Individual Application **
The individual Application form may be provided by referral. Once it is completed it should be sent to the Freedom House. Individuals should also bring personal identification when entering the program. These items include Social Security Card, Driver’s License, and a copy of a birth certificate or other proof of identification. This fee may be waived at the discretion of the BCS family.
Individuals also need to bring enough funds in the form of check or money order to cover the cost of a return trip home should they leave or be dismissed from the program.

**Individual Confidentiality**
The confidentiality of individual records maintained by Freedom House is in conformance with Federal Law (42 CFR part 2). Generally, Freedom House will not say to a person outside the program that an individual attends Freedom House, or disclose any information identifying that person as an individual. Unless: (1) The individual consents in writing; (2) The disclosure is allowed by court order; or (3) The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation. Freedom House shall make available any information about a crime committed by a individual either at Freedom House or against any person who works for Freedom House or about any threat to commit such a crime. Also, any information about suspected child abuse or neglect would be reported under State law to appropriate State or local authorities.

**Program Guidelines and Rules**
The pursuit of a new life, free from the restraints of life controlling blockages to be strong enough to handle the freedom of choice,  needs the benefit and empowerment of rules and guidelines. Freedom House has worked with individuals for over 50 years discipling them in faith and leading them through the process of restoration. Guidelines and rules, like the ones listed below, have helped individuals recover while living in safe and healthy environments. Individuals will be given a more complete listing of the guidelines upon enrollment. The purpose here is to give individuals a general idea of what to expect.

Mail, Telephone and Visitation Privileges: during the first four (4) weeks of enrollment, phone calls, mail and visitors will be restricted. This four (4) weeks week period gives the individual an opportunity to focus on their life problems and why they have entered the program. Mail will be held for the individual after this time of orientation. Freedom House participant(s) may have contact with the “immediate family” during this two (2) week period.

Two telephone applications are used to communicate with participants. Life 360 and Slack. These are required for your participation in the program.  

1. Contact with individuals through the mail, telephone, and visitation privileges will be limited to the individual’s “immediate family” and approved individuals. Immediate family shall include parents, spouse, and children. Girlfriends, boyfriends, fiancée(s), and significant others are provided limited access to an individual while enrolled in the program.
2. Separated married partners mail, telephone and visitation privileges shall be permitted by the mentor's approval, based upon the direction of the relationship.
3. Married individuals are not permitted to correspond, telephone, or visit with the opposite sex other than their immediate family members.
4. The designated mentor will approve those individuals who may correspond, phone, or visit an individual while participating in the Freedom House program.
5. Individuals are assigned a specific evening and time to place or receive their allowed phone calls.
6. Bedrooms are off-limits to ALL visitors of the opposite sex.
7. Visitation day is scheduled for a specific day and time and must be followed.
8. Freedom House activities and program requirements have priority over individual visitation privileges. 
9. Freedom House reserves the right to approve, deny, and/or monitor all mail, telephone calls, and visitation guests for drugs and anything that may be harmful to the individual’s progress, safety, and welfare.

**Scheduled Activities, Volunteer, Medical, Therapeutic**
Individuals shall participate in all scheduled activities unless excused by a medical doctor.

**Medical Expenses**
All medical and dental expenses incurred by individuals while enrolled in the program shall be the responsibility of each individual.

**Smoking**
Freedom House remains, for those who can, a smoke/tobacco substance-free environment. Those who have a nicotine addiction are advised to quit because of Freedom House guidelines. Some are able to do this "cold turkey". Others are may need to approach assistance in order to become free of their nicotine addiction. In either case, it is the individual's responsibility to handle their nicotine intake.

 
**Personal Property**
Each individual is to be responsible for the property they bring into the program.
Freedom House is not responsible or liable for any loss or damage to personal property.

1. All individual money shall be kept in and disbursed from the “Individual's Account”. This account is managed by the mentor. Each individual shall be permitted to have a maximum of$80.00 per month for personal spending.

2. Individuals are not permitted to bring personal vehicles such as cars, motorcycles, or bicycles without prior approval. The vehicle must be in good working order, have valid insurance and licensing. Individuals must have a valid Florida license. Individuals are not permitted to bring pets while enrolled in Freedom House.

3. Personal electronic devices for music, TV/Movie/video, or video games are permitted. Secular music, gambling, and card play are not permitted.

4. The individuals may bring wallets, watches and wedding rings.

5. Suitcases will be checked coming into the program and going out. Each individual may bring only two
(2) suitcases or one (1) trunk. No trips will be made to pick up other personal belongings after the individual has been admitted into the program.

6. Materials or behavior associated or identified with witchcraft, astrology, or anything related to demonic acts of worship are not allowed.

7. Illegal Drugs or alcoholic beverages are not permitted on the property, unless in designated space.

8. An individual who is dismissed or who voluntarily leaves the program must take all of their personal property with them at the time of program departure. Freedom House will not be responsible for any personal property left. Such items shall automatically be donated if the items are not picked up by the individual within 5 days.

**Dress Code**
The Individual shall maintain a neat and acceptable dress standard. Modesty is the main goal, so no skin-tight clothes, halter tops, short shorts, or revealing dress. Gang or street attire is not permitted. Undergarments shall be worn at all times.

**Searches and Testing**
Freedom House reserves the right to conduct room searches, and if necessary, a physical search of the individual for drugs and anything harmful to the welfare of the program and residents, or in conjunction with a violation of the “Program Handbook”.
Freedom House reserves the right to require individuals to submit to drug testing upon demand. Refusal to submit to such testing shall be grounds for immediate dismissal.

**Freedom House and Affiliate Property and Mentors**
Individuals shall not argue, dispute, or debate a directive given by a staff member/peer support or another person who is placed in charge. Individual submission to staff authority and obedience are required. Defiance to mentor personnel or their directives is grounds for automatic dismissal.
Foul or abusive language will not be tolerated towards an individual or staff person.

Proper care of Freedom House property is expected and required at all times.
Individuals are financially responsible for any malicious damage and subject to dismissal.

**Individuals and their Children**
Individuals enrolled in the Freedom House who have children, but are divorced, separated, or unmarried to the biological mother shall abide by the following policies:
(a) Individuals may visit with their children, but they (the children) must be brought to the center by someone who is approved. (b) Individuals may write letters directly to their children.
(c) Individuals may receive letters directly from their children.
(d) Individuals may receive pictures of their children.
(e)  Individuals give permission for photograph of themselves and children to be used  to share the story of freedom during their stay at the program. 

Individuals in our mothers and children:
(a) I understand and agree there is no co-sleeping with children. 
(b) I understand I must obtain childcare with in two weeks of moving into program. 

There is a $1350.00 monthly program fee sought to be covered by the individuals, friends and family pledges. This is based on a sliding scale. Fee scholarships are provided by organization as needed. As of June 1,2025 you have two weeks to find a job and you are responsible for program fees upon entry of the program. Unless otherwise discussed and agreed upon in writing. There is a non-refundable $250 intake fee that is required upon entry into the program. 

A limited number of scholarships are available to individuals if it is determined by Freedom House that there are no available resources to them. These scholarships may be applied for through the Freedom House.
By filling out this application you agree to the following items:  

**Medical Information** 
Once an individual enters Freedom House all their attention needs to be centered on recovery and the process of change. When it is necessary for immediate entry, and bed space is available, individuals may enter the program providing an appointment is made and realized within the first 30 days. PLEASE understand we are not a medical facility. 

Changes made 9/3/23, updated 4/28/25, updated 10/6/2025
APPLICATION
Please remember this is absolutely CONFIDENTIAL information.
First Name *
Last Name
Telephone Number
Address
City *
State *
Zip Code
Social Security Number *
Home Phone / Work Phone / Best Contact Phone *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Place of Birth *
Do you have a Driver's License? *
If yes, is it expired or suspended?
Clear selection
If no, Driver License Number & State
Health Insurance?
Clear selection
Provider & Policy Number
Primary Care Physician
Clear selection
 Physician Name
 Primary Clinic Address
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