Holy Ghost Revival Ministries’

MACK HOUSE of WESTERN WASHINGTON

360-435-3973

Clean & Sober Housing Application

This packet will explain the resources available to you through Mack House of Western Washington. Please Read Completely & Carefullyall Rules and Regulations. Our housing can be transitional or permanent, depending on your needs. You are the one to decide if and when you are ready to move out into the community.

Fees begin at $450.00 month & go up for a shared room. All move-in fees must be paid by or upon your move-in date. Beds are on a first come, first serve basis. If you would like to reserve a bed, all of your move-in fees must be paid ahead of time before you can submit one of our addresses.And we will hold a bed for you. The total move-in fees for a shared room are$850.00. If the address is turned down by DOC, you can submit one of our other addresses and if that one should be turned down, you will get your monies returned to you. But, if you decide that you do not want to come to the Mack House, and would rather go somewhere else, your monies will not be refunded because we held the bed for you.

We accept all persons as well as registered sex offenders (all levels) and paroling sex offenders who will be on supervision, as long as the Marysville DOC accepts them. All fees must be paid before your move-in date. If you qualify for a DOC Voucher to pay your rent, it must be approved by DOC before releasing and in our hands upon moving in. Voucher approval covers everything for 90 days.

All of our homes are Christian, with mandatory weekly church service & bible study. Private counseling is available upon request.

Availability of beds changes from time to time, so keep in touch with us.

Shared Room$450-$500month

Private Room$450-$650 month

Included in price is: Utilities, Cable TV, House Phone, Bed & Dresser, plus full use of the home’s kitchen, bath, laundry, etc.

EXAMPLE:

Clean & Sober Housing Move-In Feesfor a Shared Room

1st month rent $450.00 + ½ month’s rent $225.00 + $175.00 non-refundable maintenance fee

Total Move-In Fees for a Shared Room = $850.00Must be paid in full before moving in!

**IMPORTANT ** Please Note:

*** Mack House is requiring all applicants to pay their move-in fees in full before accepting any of our addresses for your release. If your release date is more than 6 mos. out,submit the address but do not send any money at this time. Wait till it’s 60 day’s out. ***

MackHouse Release Address:

Intake House Address: 18816 Smokey Point Blvd Arlington, WA 98223 (on bus line)

We have 10 houses total. As beds come available, you canrequest to move.

Print Name: ______

DOC#: ______Your PrisonAddress: ______

______Doc bed # ______

Birthdate______Will you be receiving any state or government assistance? ______

Source of Assistance ______

Who’s paying move-in feesfor you? ______How much is being paid? ______

Release Date: ______Sex Offender? ______Level? ______

Marital Status: Married _____ Separated _____ Divorced _____ Single _____

Are you an Alcoholic and/or Addict? Yes ______No ______

If so to what drugs are you addicted? ______

Are you taking any prescription drugs? Yes _____ No _____

If so list the names of drugs ______

DOC OFFICE & OFFICER’S NAME: ______Phone: ______

EMERGENCY NAME & NUMBER ______

**Describe Your Criminal Historyas well as Reasons for Present Incarceration on the back of thisApplication. Include Your Present Sentencing & Supervision Requirements. Failure to be truthful can lead to expulsion from our homes.**

PLEASE RETURN COMPLETED APPLICATION. MUST BE SIGNED & DATED WHERE REQUIRED & INITIAL ALL OTHER PAGES.

ORIENTATION

Read these rules carefully. In order to keep peace and have an organized house these rules must be followed. Any failure to follow the rules will result in fines or eviction, depending on the violation.

**Rules are subject to change** depending on conditions at the house to provide for a peaceful ongoing clean & sober environment. You will always be notified of any changes.

MAJOR RULES:

NO Drugs, Alcohol, Weapons, Fighting, Stealing, Disruptive Behavior!

  1. PAYMENT OF RENT
  2. All rents & fines are payable to Mack House of Western WA.

It is the responsibility of the member to make sure Pastor Mack receives payments.

  1. Rent is due on the 1st of each month. Members will be charged a late charge of $5.00 a day for any payments made between the 2nd & the 14th of the month.
  2. Unless arrangements have been made with the Pastor for an extension, if your rent has not been paid in full by 6pm on the 14th of the month, you must vacate the premises. See “Expulsion” at end of agreement.
  1. ROOMS
  2. You will occupy your own room.
  3. Do not enter another member’s room without their permission.
  4. All rooms become available by seniority.
  5. NO PORNOGRAPHY ALLOWED. Not in your room or in the house.
  6. Your room is to be kept reasonably clean.
  7. You may not paint your room without permission from Pastor Mack
  8. No pets of any type are allowed.
  9. Rooms will be inspected without notification.
  10. Because of fire hazard/system overload concerns,the Pastor or agent must pre-approve any electrical sound systems or other appliances before they are used in a member’s room.
  1. CHORES:
  2. You will be assigned a daily or weekly cleaning chore.
  3. Failure to do your chore or to sign off your chore on the chore list will result in fines and/or other penalties.
  1. LAUNDRY:
  2. Laundry hours are: 8 am to 10pm Mondaythru Sunday

F.QUIET HOURS:

  1. Quiet hours are in effect 10 pm to 8 am daily.
  2. Stereos, TV’s & loud talking must not be so loud as to disturb others.
  1. TV/LIVING ROOM/GAME ROOM USE:
  2. There are no time restrictions on TV time use.
  3. The TV is on a first come, first serve basis.
  1. RELATIONSHIPS:
  2. Relationships of a romantic nature are not allowed between house members, regardless of sexual orientation.
  3. No sleep overs without permission.

Initials: ______

  1. DISPUTE RESOLUTION:

1. Pastor John/Pastor Jane will settle all disputes if it cannot be worked out amongst the

members of the household.

  1. FOOD:
  2. A storage shelf,shared refrigerator and shared freezers are provided.
  3. A pantry is provided by the house with free food.
  4. Eating someone else’s food without permission constitutes stealing.
  1. KITCHEN USE:
  2. Kitchen and stove use are on a first come, first serve basis.
  3. You are expected to clean up & wash your dishes after you’re done.
  4. All needed utensils & dishes are supplied by the house.
  1. TELEPHONE:
  2. Long distance call service is not available.
  3. The house phone is not allowed in your room.
  4. You are not required to answer he phone when it rings, but if you do, you are required to look for the person the call is for, or take a written message for them.
  5. Limit your conversation to 15 minutes.
  1. CHURCH SERVICES &HOUSE MEETING (Mandatory) Initials: ______
  2. Mandatory Church Services: Sunday 10am – Wednesday 7pm. You must attend.
  3. If for any reason, you need to miss a meeting, you must notify your house manager or Ptr. John or Ptr. Jane at least 1 hour before the meeting begins and get their permission or you will be fined – no excuses.
  4. You must be on time for the meetings. Extra chores will be assigned accordingly.
  1. CLEANLINESS:
  2. Your mother does not live here, so you must clean up any mess you make.
  3. Do not make a mess & expect the person with chore to clean up after you. You will be penalized!!!
  4. This also goes for personal hygiene, toilets & showers.
  1. HOUSE SUPPLIES:
  2. The house supplies the following items:

Toilet Paper, Comet, Light bulbs, Dish soap, Sponges, Trash bags.

  1. VISITORS:
  2. Nofemale visitors allowed except to attend church services and/or bible study. They come for services and must leave immediately thereafter. Visitors are subject to each & every house rule and visitors are your responsibility. Whatever they do, you did. If they use, you used and you’re out!!!
  3. No overnight visitors allowed unless approved by Pastor Mack.
  4. No minors allowed.
  5. You may not leave your visitors in the house while you leave.
  6. Do not allow the visitor to roam the house or go directly to the person’s room.
  1. AUTOMOBILES:
  2. 1 Auto per member is allowed.
  3. Auto must be registered, licensed & insured to member or vehicle will not be able to park on any Mack House property.
  4. If your car is not running, it needs to be fixed within 1 week or removed from property or it will be towed at your expense.
  1. SMOKING
  2. Smoking of cigarettes or e-cigarettesis Not allowed inside the house.
  3. You must go outside to smoke and the cigarette butts are to be disposed of immediately. Not stacked up outside in a container.
  1. EXPULSION: Read This!!
  2. If you are kicked out of the house, you have exactly 15 minutes to get some of your things and get out! Your house key must be surrendered immediately. You must call and set up a time to come collect the rest of your things; you have three (3) days to complete this.
  3. The rent you have paid & all deposits are forfeited. Initial: ______
  4. The House Manager/Chore Coordinator will clean the room & will remove all food & other items from the refrigerator.
  5. If money is owed to the house, I agree that any and all of my possessions at the Mack House can be held as collateral, and if not retrieved within 30 days they can be disposed of in any manner Mack House sees fit.
  1. CHRISTIAN HOME
  2. You are living in our“Christian” Clean & Sober Homes. Behavior is expected to conform to Christian attitudes and principles.
  3. Only Christian Literature is allowed in the House. You will not be allowed to bring literature or artifacts from non-Christian organizations such as: Jehovah Witnesses, Mormon, Native American, Muslim, Wicca, etc.
  4. If you show a bad attitude in the home or during our services or complain about having to attend church services, you will be required to move out of our home.

The nature of the Mack House is immediate expulsion without notice of a resident member who is found, by the Pastors Mack and/or the majority of the house members, to be using either alcohol or drugs. Disruptive behavior or nonpayment of rent can also lead to expulsion from the Mack House. THE WHOLE HOUSE, AS WELL AS PRIVATE BEDROOMS ARE SUBJECT TO SEARCH AT ANY TIME (INCLUDING ANY VEHICLES LOCATED ON PREMISIS). FAILURE TO ALLOW SEARCHES FOR COMPLIANCE WITH HOUSE RULES WILL RESULT IN IMMEDIATE EXPULSION FROM PREMISIS. Expulsion will also be mandatory for refusal to do any required drug/alcohol testing.

_Initials: ______

Living in the Mack House is by membership only. The Mack House does not fall under the landlord/tenant act. This means that a resident can be voted out of the house for violations of the house rules, including but not limited to: not doing required chores, non-payment of rent, leaving windows or doors unlock, etc. The time given to move out will be determined by the current members of the house or the owners.

Violations such as using drugs or alcohol, disruptive behavior, or possessing a weapon will result in the resident member being given 15 minutes to gather their immediate belongings and vacate the house and premises.

I have read the items in this agreement and understand that if I am accepted into the Mack House, I agree to the terms listed and I waive any landlord/tenant rights that I may be entitled to. I also understand that I fully and freely subject myself to the rules of the Mack House of Western Washington. I also agree to accept Pastors John & Jane Mack as my Pastors, and agree to make an effort to live a Christian based lifestyle while residing in the Mack House.

Signature ______Date ______

Print Name

INFORMATION RELEASE AUTHORIZATION

I,(print name) ______do hereby authorize the release of any and all information deemed both public and confidential to Pastors John or Jane Mack, Overseers of the Mack House of Western Washington. This covers all Court Reports, Department of Correction’s Reports, (both physical & psychiatric) and any other information deemed necessary for the treatment and/or safety of beneficiaries within the Mack Houses.

This authorization, unless expressly limited by me in writing, is applicable to records pertaining to diagnosis and/or treatment for alcoholism and/or substance abuse, testing and/or treatment for HIV/AIDS and/or sexually transmitted diseases, and diagnosis and/or treatment for any mental health or psychiatric condition. This authorization includes the release of such information when it is integrally related to the diagnosis and/or treatment or a condition specific to this request.

SignatureDate

Print Name

P.O. Box 3688 Arlington, WA 98223

Phone: 360-435-3973 Fax: 360-403-9761

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