Application for Admission
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Disclaimer: Scope of Services

The Boaz House is a faith-based, non-clinical recovery program designed to offer spiritual guidance, life skills development, and supportive community living for women in transition. While we are committed to creating a safe and nurturing environment, we are not a licensed clinical treatment center and do not offer medical, psychiatric, or licensed therapeutic services.

Our services are limited to the scope, experience, and qualifications of our staff and volunteers. We are not equipped to manage individuals with severe mental health diagnoses, active psychosis, untreated eating disorders, or those requiring inpatient detoxification or intensive clinical care.

Participants are encouraged to maintain coordination with medical professionals, licensed therapists, or treatment providers as needed. Admission and continued participation at The Boaz House are contingent upon our ability to safely support each individual within our program structure and staff capacity.

We reserve the right to refer individuals to more appropriate services if their needs exceed what we are equipped to provide.

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Email *
First Name *
Last Name *
Address *
Date of Birth *
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Email address *
Phone Number *
How did you hear about the Boaz House? *
Have you been to the Boaz House before? *
The Boaz House is a faith-based, one-year residential recovery program. Are you willing to commit to this duration?   *
Who are you living with now? What is your relationship? *
Can you return there when you leave the Boaz House? *
Marital Status *
YOU MUST BE DETOXED PRIOR TO COMING TO THE BOAZ HOUSE! WE ARE NOT A DETOX FACILITY.  *
Emergency Contact Name and Relationship *

Emergency Contact Address (House#, City, State, Zip) *
Emergency Contact Phone Number *
Do you have any life-controlling problems such as drug and or alcohol addiction, gambling, anger, lying, stealing, spending, sexual, or other? *
Check all the drugs/substances that you have used.  *
Required

Are you court ordered to attend a program? *
When was the last time you used any substances (drugs or alcohol)? What substance did you use? *
Have you ever been to a treatment center for drugs and alcohol before? *
If you answered yes to the previous question, provide the name of the center and how long you were there.
Do you have a criminal record? (Check all that apply)

Do you have a conviction or pending conviction for any violent offenses? *

YOU MUST TAKE CARE OF ANY OUTSTANDING WARRANTS BEFORE COMING TO THE BOAZ HOUSE *
If you are currently taking any prescription medications, please list those medicines here. 
Have you ever attempted suicide or used self harm as a way to cope? *

How would you rate your health? 1=poor 10=best *
Poor
Best

Work Participation & Physical Requirements Statement

As part of the recovery journey at The Boaz House, participants are expected to contribute to the daily upkeep and beautification of our properties through structured workdays. These work assignments—ranging from deep cleaning and organizing to lawn care and assisting with donation-based activities—are designed to instill responsibility, accountability, and community stewardship.

One of our primary fundraising efforts includes a recurring yard sale, in which all participants are expected to take part. This includes tasks such as setting up, lifting, moving large pieces of furniture and appliances, sorting donations, pricing items, and cleaning up.

To ensure each participant can safely and effectively engage in these activities, we ask that all applicants confirm their ability to:

- Lift and carry up to 40 lbs

- Work outdoors in the Texas heat for up to 4 hours at a time

These physical requirements are essential for the health, safety, and functionality of our community. If you have any medical limitations or concerns, please disclose them during your intake interview so we can determine reasonable accommodations, if applicable.

I can safely lift 40 lbs.  *
I can work outdoors in the heat for up to 4 hours. *

We DO NOT ALLOW certain medications including but not limited to: Narcotics, Tramadol, Benzodiazepines, Seroquel, Gabapentin, Gralise, Neurontin, Horizant, Fanatrex, or Ranitidine.  *
Do you have health insurance? *
Do you receive SSI/Disability benefits? *
When is the last time you were in the hospital and why? (Dates and reason) *
We are offering help on our terms. Are you willing to receive this help? *

This is a non-smoking facility (including vaping). Are you willing to live in a smoke-free environment?

 *
 Why are you seeking help from The Boaz House at this time?   *

I attest that all information I have submitted on this application to be true and correct. I understand that any deception or failure to disclose pertinent information may cause my application to be rejected. (Printed name and date) *

After completing application please call or text us at 713-205-1136. 
We will get back to you as soon as we can. 

***NOTE*** The Boaz House is not a clinical treatment facility. 
Our services are limited to the scope, experience, and practice of our staff and volunteers.
A copy of your responses will be emailed to the address you provided.
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