Intake Application

 
Name *
Name
Phone Number *
Phone Number
Are you a returning resident? *
Do you have a valid government issued ID? *
Have you ever been convicted of a sex offense? *
Do you have any felony or misdemeanor warrants in any county? *
Have you ever been convicted of arson? *
Are you currently on parole or probation? *
Have you fully detoxed from all mood altering substances? *
(This includes alcohol)
Signatures and statements
* By completing this form you understand and state that your electronic signature & intials are valid for signing this electronic document *
I understand & agree that NFTL is NOT a medical facility nor provides any medical services of any kind. *
I understand & agree that once I gain entry, NFTL does not issue refunds of any kind for fees paid. *
I understand & agree that NFTL is not responsible for any lost or stolen property. *
IF YOU HAVE ANY QUESTIONS OR COMMENTS, PLEASE ENTER THEM IN THE form BELOW.