Application - Prodigal Recovery

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.

Name *

First

Last

Email *

Today's Date *

Birthdate *

Phone Number *

Name and Phone Number of Closest Relative in Case of Emergency *

Pending Court Dates (and County)

Are you a registered sex offender? *

If you are in rehab, do you give me permission to speak to your counselor? *

If so, please provide the name and phone number of your counselor

If you are incarcerated and will be on probation, please provide probation officer’s name and number

What is your anticipated date of arrival at Prodigal Recovery? *

Current Medications *

Employment/Desired Employment *

Hobbies/Interests *

Allergies *

Faith in God? *

Expectations of Prodigal Recovery? *

If you have past experience in recovery, what are you willing to do differently? *

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

Personal comments

I agree to and have read and fully understand all terms and conditions in the Prodigal Recovery Structured Living Plan. I understand that I am 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 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. *

Signature, Date