Prodigal Recovery

Application

If you would like to submit an application to join our community at Prodigal Recovery, please fill out the following form.

If you have any questions, please message Prodigal Recovery CEO Mark Marcley at this email.

Before you start

Read the Rules/Fees. The form asks you to agree to them.
Have ready: your emergency contact’s name and phone, any pending court dates and counties, and your current medications.

Name *

First

Middle

Last

Email *

Date *

Today’s date

Birthday *

Phone Number *

Closest Relative / Emergency Contact *

Relationship *

Phone *

Pending Court Dates – Date

Pending Court Dates – County

Current Medications *

Employment/Desired Employment *

I I Phone

Work Experience *

Hobbies/Interests *

Allergies *

Faith in God? *

Expectations of Prodigal Recovery *

Past experience in recovery, what am I willing to do different? *

Where would I like to see myself by the time I move out? *

Personal comments

Agreement *

I agree to and have read and fully understand all terms and conditions under Prodigal Recovery Rules/Fees as outlined on this web site. I understand that I am applying to become a member of Prodigal Recovery not a resident and my membership may be terminated at any time giving me one hour to pack and vacate the property. I also understand and agree that by becoming a member of Prodigal Recovery that Prodigal Recovery is not governed by the NC Real Estate Commission. Therefore, I accept that I can be discharged from the premises immediately without due process of law, should it be determined by the director and/or management to be in the best interest of the house and/or other house members. I agree to remove any and all of my possessions remaining within 48 hours after my membership termination with approval from management. Coming onto our property without permission from management is against the law and will be considered trespassing. I understand that any of my belongings remaining after 48 hours will be forfeited and become Prodigal Recovery’s property. Acquisition of my belongings can only be retrieved if I have fully paid back dues. Should I refuse to leave the property immediately upon membership termination the local police department will be called to escort me off the property. I understand failure to comply with any of Prodigal Recovery’s rules and policies may result in membership termination. I understand that these rules and expectations are subject to change, and I agree to these changes. If we find you have withheld and/or falsified any information on this application your membership will be terminated. I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing or typing my name on this form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.

Signature *

Typing your full name here is your signature.

Date Signed *