ADMISSION AGREEMENT

Initial here:

I N D E X

1. INTRODUCTION

2. RULES AND REGULATIONS

3. 12-STEP MEETINGS

4. STEP WORK

5. SPONSOR

6. SERVICE

7. TIMETABLE

8. MEALS

9. CURFEW

10. WEEKEND OUT

11. DRUG TESTING AND BREATHALYSER

12. TIDINESS

13. CLEANLINESS/THERAPEUTIC DUTIES

14. VISITORS

15. HOUSE MEETINGS

16. GAMBLING

17. NIGHTCLUBS

18. ENERGY DRINKS

19. TATTOOS/BODY PIERCINGS

20. ACCOMMODATION FEES

21. CONDITIONS OF ADMITTANCE

22. COMPLIANCE WITH HOUSE RULES

23. LOSS OR DAMAGE TO PROPERTY AND/OR INJURY TO PERSONS

24. ACCOMMODATION TO BE PROVIDED

25. CLOTHING/EQUIPMENT/ADDITIONAL FURNITURE/LINEN/TOWELS TO BE

PROVIDED BY EACH RESIDENT.

26. TERMINATION OF RESIDENCE

27. MEDICAL CARE AND EXPENSES

28. RESIDENT APPLICATION QUESTIONNAIRE

Initial here:

1. INTRODUCTION

St Georges reintegration and life skills facility offers a safe living environment for men and women in

recovery providing a focused transition between primary care treatment and living in day-to-day society.

The vision of St Georges is to provide a safe, structured environment in which individuals are guided

and encouraged in developing routine, balance and building a solid foundation in recovery. St Georges

provides comfortable accommodation and offers a range of therapeutic support and additional

amenities, to ensure that each resident is afforded the platform to grow and develop, at a manageable

pace.

The St Georges Multi-Disciplinary team, guides residents through the transition from learning, to

implementing the use of tools and skills developed in Primary Care Treatment. Residents are afforded

freedom within the structure of our rules and regulations, as well as the benefit of an individual

reintegration plan.

2. RULES AND REGULATIONS

2.1. No drugs and/or alcohol may be used by the residents.

2.2. No drugs and/or alcohol to be brought onto the property.

2.3. No sexual or romantic relationships may develop between current residents or between

staff.

2.4. Violence or physical harm towards oneself or to others living on the property is

prohibited.

2.5. Suicidal threats/ideations will not be tolerated and appropriate action will be taken to

ensure the safety of the individual and fellow residents.

2.6. No resident may have friends, family or partner sleep over.

2.7. Malicious and/or intentional damage to others property and/or property belonging to St

Georges is prohibited.

2.8. Bribery, theft, fraud, forgery and dishonesty is prohibited.

2.9. Any behavior that causes or intends to cause bringing St Georges into disrepute will not

be tolerated.

2.10. Smoking in the house and outside of designated smoking areas is prohibited.

2.11. Residents are not permitted to travel together for any reason including: to support group,

to Church, to the shops, on a road trip; unless instructed by/approved by management.

2.12. NO LENDING / BORROWING - MONEY , CLOTHS , ITEMS , AND

FOOD TO ANY RESIDENT OR STAFF MEMBER.

Initial here:

A BREACH OF ANY OF THE RULES WILL LEAD TO YOUR IMMEDIATE EXPULSION

Along with the above-mentioned rules and regulations, St Georges has a number of expectations that the

residents must follow:

3. SUPPORT GROUP MEETINGS

There will be compulsory attendance to weekly Support Group meetings. St Georges will provide

transport to the venues during the initial 3-week period or if the resident does not have a vehicle.

Testing will be carried out at the Support Group meetings and is for the residents own account (see fee

information for costing).

4. STEP WORK

Residents are expected to be involved in written Step Work and to follow a Step Work schedule with the

guidance of a Step Work counsellor.

5. THERAPEUTIC TEAM

Residents are expected to take part and engage in the therapeutic programme. Attendance to all

individual, family and group sessions is compulsory.

6. EXERCISE AND MULTI SPORT PROGRAM

Involvement in the exercise programme is compulsory, each resident is expected to part-take at his or

her own pace. Medical advice will be sought for those who have medical concerns, prior to embarking

on the exercise regime. Exercise and allowing oneself to engage in different activity’s that they would

have not in the years of active addiction introduces an individual to new experiences and lifestyles they

might have never engaged in previously.

7. TIMETABLE

Residents are expected to adhere to the stipulations of the daily and weekly timetable. This will be

discussed during initial induction and orientation.

All residents need to engage in some form of self-development i.e. employment/studies. Should the

resident be unemployed, facilities will be provided to assist the individual in finding employment and

preparing him/her for the process of obtaining employment.

8. MEALS

The St Georges menu is approved by a registered dietician and offers nutritious and delicious meals.

Care is taken to ensure that each residents’ dietary requirements are met. Should an individual have any

medical requirements in terms of meal preparation, he/she will be required to consult with our dietician

Initial here:

Residents are expected to attend meals whilst on the property.

St Georges has an onsite cook for meals during the week; all weekend meals are to be prepared by

residents. Items will be available in the kitchen for light meals to be prepared. Residents are welcome to

provide additional food items to suite their taste, at their own expense.

9. CURFEW

Sunday evening’s to Thursday evening’s residents will be required to sleep in, unless special

arrangements have been made with families.

• Residents: From arrival to 3 weeks are expected to spend weekends on site. Family visits are

allowed with prior arrangement and management approval, should a resident who falls into this

time frame be requested to go off the property with his family it will need to be cleared with

management.

• Residents: From Week 4 onwards are encouraged to spend weekends with family. Residents may

depart from 16:00 on Friday afternoon and need to return to St Georges by 17:00 on Sunday

evening. Should individuals be employed they may leave straight from work and return on Sunday.

• Residents in their final 5 weeks (and with approval from management) can arrange to spend

weekday nights over with family or their spouses. This is not a right and will be assessed

individually.

10. DRUG TESTING AND BREATHALYSER

Residents are tested at least once per week and are subject to spot drug testing throughout their stay,

and at managements discretion. Testing will be done immediately on return from weekends out. One

drug test per week is provided in the treatment fees, any additional testing will be at a cost of:

7 panel urine multi drug test: R55.00 per test

1 panel urine alcohol test : R 45.00 per test

11. TIDINESS

All residents are expected to clean up after themselves, and keep their rooms and living space clean and

tidy. Residents are expected to make their own beds and to keep their cupboards neatly packed. House

keepers and grounds men are employed for the upkeep of the facility but it is vital that residents take

responsibility for themselves and their area.

12. CLEANLINESS/THERAPEUTIC DUTIES

As St Georges is a recovery focused community programme, all residents are expected to help maintain

the cleanliness and tidiness of the house, grounds and pool area. A roster is drawn up to designate duties

to specific residents. A daily allocation of 30 – 40 minutes is provided to get these tasks done.

Initial here:

13. VISITORS

All visitors to the property may only arrive by prior arrangement with management – at least 24 hours’

notice needs to be provided. Visitors will be expected to sign a visitors guidelines document on arrival

Only immediate family/spouses are allowed, please note that if your name is not on the visitors list you

will not be allowed onto the premises.

Visitors may not bring drugs or alcohol onto the premises nor enter the property while under the influence

of any substance. All items brought onto the property will be searched and are to be handed in to

management before being issued to any resident.

A same-sex member of the St Georges staff will search any items, packages or shopping brought in by

the resident and/or any family member or third party. St Georges reserves the right to confiscate and/or

report any items deemed inappropriate/illegal.

Visitors may not enter residents bedrooms at any stage.

Visitors must strictly adhere to the times on Saturdays and Sunday (13h30 to 17h30)

1. HOUSE MEETINGS

House meetings will be held every morning to address the layout and schedule of the day.

General house meetings will be held weekly to discuss house issues and any points that need addressing.

2. NIGHTCLUBS

Residents are prohibited to attend nightclubs, sports bar-type restaurants (The Dros, Hooters etc) and

brothels. Residents are expected to live a life-style focused on the freedom provided by recovery.

3. ENERGY DRINKS

No resident may bring on the premises any energy drink. Residents are also not allowed to consume

these energy drinks during their stay with us under any circumstances.

4. PERSONAL HYGIENE

Learning to take care of your health is vitally important in recovery. All residents at St Georges are

required to bath/shower daily. You should brush your teeth twice daily and you will be expected to keep

your appearance neat and tidy.

Initial here:

5. CAR POLICY

Residents are welcome to park their vehicles on the St Georges premises at their own risk, if space is

available.

If for whatever reason you are found to be under the influence of drugs or alcohol, we are legally bound

to withhold your vehicle until such a time where you are no longer under the influence. Refusal to

comply with handing over of car-keys will result in management contacting the police for the safety of

the resident and for the safety of the general public at large. All vehicles are subject to be searched at

management’s discretion, a vehicle log book will be bought at the resident’s expense to monitor mileage

etc.

6. TATTOOS/BODY PIERCINGS

No body piercings or tattoos may be attained by the resident while in the care of St George.

7. ACCOMMODATION FEES

Guarantor and Resident by signing this agreement enter into and conclude a month-month

accommodation contract with St Georges.

A deposit of R 3,000.00 (three thousand rand) secures a bed at St Georges. Please see the finance

agreement for terms relating to deposit refund on departure.

An accommodation fee of R 9,000.00 (nine thousand rand) per month is due and payable in

advance on or before the first calendar day of every month. A daily prorate amount will be charged

for days outside of a month period, on admission or discharge to or from St Georges.

Should the resident leave St Georges or be expelled by St Georges, that month’s accommodation

fee and the booking deposit is not refundable.

The accommodation fee of R 9,000.00 per month provides for, but is not limited to, the following:

• One on one counselling with both our addiction councilors and social workers.

• Specialized counselling such as trauma, eating disorders etc are available from our private doctors

at an additional cost.

• On site testing and monitoring.

• Access and transport to the appropriate faith based support groups.

• Goal setting and practical applications to achieve said goals (I.R.P- Individual reintegration

program)

• Family groups.

• Family education and referral to the appropriate family/supporter support groups.

• Big Group formats.

Initial here:

• Ongoing lessons and education of the process of addiction and recovery relevant to the stage the

individual is in recovery.

• Disciplined, accountable and transparent environment. (please read our rules and regulations)

• Councilors and monitoring on site 24/7 for the resident’s wellbeing and the facilities safety.

• Spiritual 12 step program and step work monitoring.

• Bible study and home cell groups.

• An active life style is not only encouraged but is compulsory at the house on St George. All

residents will make use of the gym, boxing training (if enough residents want to take part, lady’s

welcome) and/or running for at least one hour, 4 days a week minimum/6 days a week maximum.

• Fully encompassing electric fence.

• 24 hour armed response, and fully boomed off and guarded entry points (Observatory estate is

exclusively safeguarded by stallion security)

• Pool and entertainment area.

• DSTV premium.

• Wi-Fi and computer access. (exclusively to look for employment within set times)

8. CONDITIONS OF ADMITTANCE

• Completion of a Primary Care treatment programme (in-patient or out-patient). A referral

confirming readiness from a treating professional is required.

• Willingness to enter a reintegration programme and commitment to adhering to the structure and

accountability of the programme.

• Pre-admission assessment by St George management team member.

• Medical safety of admission – Regrettably St Georges does not have frail care facilities.

9. COMPLIANCE WITH HOUSE RULES

All residents shall be subject to the rules and regulations imposed by St Georges.

Visitation by parents/guardians, family and friends must be approved by the staff and such approval is

subject to St Georges’s rules (available on request)

10. LOSS OR DAMAGE TO PROPERTY AND/OR INJURY TO PERSONS

Although St Georges will take all reasonable and necessary precautions to prevent damage of property

and/or injury to persons St Georges will not be responsible for any loss or damage to the property of or

injury to any resident during the period of residence at St Georges, whether such occurrence results

from any act or omission on the part of any member of staff or of any other resident or through any

other cause whatsoever.

Initial here:

The resident (and parents/guardians/guarantor where necessary) fully indemnify St Georges, the staff

and any other person who may be involved in interaction with and/or care of the resident, against any

possible claims or legal action that could arise from such an occurrence.

11. ACCOMMODATION TO BE PROVIDED

St. Georges will provide shared furnished accommodation for each resident at the sole discretion of

management.

12. CLOTHING/EQUIPMENT/ADDITIONAL FURNITURE/LINEN/TOWELS TO BE

PROVIDED BY EACH RESIDENT:

Each resident is to provide all the items required by her in accordance with house rules.

Parents/guardians/guarantor are to note that they are advised to arrange their own insurance cover to

cover any possible losses sustained.

13. TERMINATION OF RESIDENCE

Residents must provide St Georges ONE MONTH written notice of his/her intention to vacate/leave St

Georges.

Residents may be asked to leave St Georges due to the development of uncontrollable or violent

behavior, or due to a deteriorating medical condition, or if the Multidisciplinary team deems the

environment to not be healthy for the individual.

14. MEDICAL CARE AND EXPENSES

Resident and guarantors will be responsible for the medical and dental expenses of the resident,

including all prescribed and other medications required, during their residence at St Georges. Resident

and guarantors are advised to arrange appropriate medical aid cover for the resident to cover these

expenses.

Residents with a medical aid or a hospital plan, the nearest hospital and twenty four hour emergency

service to St Georges, is Netcare Linksfield Hospital or Life Bedford Hospital and use will be made of

these facilities in case of an emergency or if hospitalization of a resident is required, unless St Georges

has been instructed differently by the resident, in writing.

If necessary, and where no medical aid cover is available and where resident and/or guarantor cannot

afford the cost of private health care, residents will be taken to the local clinic and/or state hospital.

In cases where, at the sole discretion of St Georges, transportation of a resident to and from

medical/dental facilities will be for the account of the resident/guarantor as determined by St Georges.

Initial here:

15. RESIDENT APPLICATION:

Particulars of resident:

Full names

Identity number

Mobile number

Work number

Email address

Fax number

Employer

Vechicle & Color Reg Number

Particulars of guarantor:

Full names

Identity number

Mobile number

Work number

Email address

Fax number

Residential

address

Postal address:

Employer

Family members/other next of kin of resident:

Full names Relationship Contact

Summary of medical information: (Please supply full & detailed information) Any special

Initial here:

condition(s) requiring care? (Epilepsy, allergies etc.)

MEDICAL AID DETAIL :

PLAN :

MAIN MEMBER : NUMBER :

ID NUMBER

Drug of Choice

Years of Abuse

Initial here:

Medication – Prescribed & other: ** LIST ALL MEDICATION ***

_

Treating medical professional (GP, Psychiatrist, Specialist treatment - full names and contact details)

Blood Group (if available) Medic Alert No:

Instructions regarding medical services if the standard procedures followed by St Georges are not

acceptable to the resident then specific instructions need to be given regarding the names of medical

practitioners and facilities to be used:

Initial here:

DECLARATION BY RESIDENT/GUARANTOR

I/We being the undersigned do hereby declare that:

• all the details supplied in this application are both true and complete and that no detail of any

relevant matter has been deliberately withheld;

• I/we subscribe to and agree with all the conditions and principles set out by St Georges

Admission Application, subject to the specific medical requirements, if any, set out in the

resident application questionnaire; and

• I/we do hereby waive and forever abandon any claim which I/we may have in my/our capacity

as parents/guardians/guarantor against St Georges, its employees, agents, nominees,

representatives or any other person in respect of any loss of property belonging to or injury to,

or the death of, the resident whilst residing at St Georges.

THIS AGREED TO AND SIGNED AT ST GEORGES OBSERVATORY ON 201

RESIDENT

St Georges house

The Guarantor unconditionally confirms and understands that should the Resident be expelled by

St Georges, be asked to leave St Georges for any reason, St Georges will not be liable for any refund

and that the Guarantor will remain liable to St Georges for the payment of the full account (NO

DISCOUNT) and this amount will become immediately due and payable by the Guarantor should

the Resident leave St Georges for any reason.

GUARANTOR

Initial here:

Initial here: