White Wings Living

Welcome to White Wings Living. Please complete the application form to be considered for admission.

First Name*

Middle Name

Last Name*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Birth Date*

Date

T-Shirt Size*

What is your Race/Ethnicity?*

American Indian or Alaska Native

White, Caucasian

Asian

Black or African American

Native Hawaiian or Pacific Islander

Latino, Hispanic, or of Spanish origin

Other

Are you a member of a federally recognized tribe?*

Yes

No

Is there a WWL staff member you have been working with?*

Yes

No

How did you hear about WWL?*

EMERGENCY CONTACTS

Emergency Contact Name*

Contact Phone Number*

Please enter a valid phone number.

EMPLOYMENT INFORMATION

Do you have a valid form of ID?*

Yes

No

Do you have a job?*

Yes

No

What is the name of the employer?*

Employment Status*

Employer phone number*

Please enter a valid phone number.

Are you a Veteran?*

Yes

No

Are you a registered sex offender?*

Yes

No

Do you struggle with mental health?*

Yes

No

Have you been a victim of human trafficking?*

Yes

No

Have you been a victim of domestic violence?*

Yes

No

Do you struggle with a gambling addiction?*

Yes

No

Do you have health insurance?*

Yes

No

Have you recently been to detox or an inpatient facility?*

Yes

No

TREATMENT INFORMATION

Which Treatment Center are you coming from?*

Case Managers Name

Are you currently or have you ever been on medication-assisted treatment (MAT)? (example: methadone, Suboxone, sublicade, etc.)*

Yes, I currently am

Yes, but not currently

No, I never have

Drug of Choice*

Are you currently on any medication? If so, please list them.*

TREATMENT INFORMATION

Do you have any current or past legal issues? If so, please describe them.*

Probation?*

Parole?*

Officer Name

Officer phone number

LICENSE AGREEMENT

Instructions:

Certify that you agree to the below items by clicking the check box.

Untitled*

I understand that THIS AGREEMENT IS NOT A LEASE and does not create a landlord-tenant relationship. This agreement is a revocable license under Oklahoma law.

Untitled*

I have read and signed the attached Restatement of the Transitional Housing Misconduct Act Form and understand that it has become a part of my housing contract.

Untitled*

I understand that White Wings Living provides and pays for Utilities, furnishings, cleaning services and controls all keys to the premises and individual rooms

Untitled*

I understand that if I violate any rules of this license agreement or fail to vacate after termination, my continued occupancy constitutes unauthorized use of the property. White Wings Living may pursue all legal remedies under applicable civil laws.

Untitled*

I understand that White Wings Living has broad authority to lien all property contained within the licensee’s room

Untitled*

I have read and understand the house rules provided to me (see addendum VIII)

Untitled*

I understand that White Wings Living is NOT an assisted living facility or a nursing home and that LANDLORD & PROPERTY MANAGER DO NOT provide assistance with activities of daily living, medicine management, bathing, brushing, shaving, cutting food, toileting, transportation, supervision outside of the residence, incontinence care, dressing, movement or other daily activities. Outsourced 3rd parties may stop by and provide these services to the “licensee” if the “licensee” has a relationship with this outsourced 3rd party, however under no circumstances does White Wings Living provide these services directly.

Untitled*

I understand that any damages (other than normal wear) will be my financial responsibility

Untitled*

Any person who is a prevailing party in any legal proceeding brought under or related to the transaction described in this license agreement is entitled to recover a maximum of $500 attorney’s fees from the non-prevailing party.

FEES

Untitled*

The licensee, licensee’s representative and/or licensee’s legal representative agree that the Resident (or other specified party) will pay the basic rate as of the date of this agreement, which is

Monthly Fee of $640

Untitled

Payment is due the 1st - 4th of each month depending on the date that the licensee receives their income.

PEST CONTROL AND INFESTATION

Bed bug addendum and other infestation:

A. This addendum addresses situations related to bed bugs and other infestations (roaches, gnats etc.) which may be discovered infesting the dwelling or personal property in the dwelling. You (licensee) understand that we relied on your representations to us in this addendum.

B. INSPECTION. You agree that you: Have inspected the dwelling prior to move-in and that you did not observe any evidence of bed bugs, roaches or other infestation

C. INFESTATIONS. Prior to move-in, Licensee is certifying that they have examined the property for bed bugs, rodents and other bug infestations and did not observe any evidence of bed bugs or bed bug infestation or any other infestations including roaches, gnats etc. Therefore, in signing this addendum, Licensee certifies that if bed bugs or other bug infestations are later found in this unit, they will be deemed to have been introduced by the Licensee or one of the Licensee’s guests and that the LICENSEE WILL BE RESPONSIBLE FOR THE PEST TREATMENT, including all reasonable costs of cleaning and pest control treatments. If we must move other residents in order to treat adjoining or neighboring dwellings to your dwelling unit, you will be liable for payment of any lost rental income and other expenses incurred by us to relocate the residents. If you fail to pay us for any costs you are liable for, you will be in default, and we will have the right to terminate your right of occupancy and exercise all rights and remedies under the lease contract. You will be held directly liable and will deal directly with city officials including but not limited to section 8 inspectors, code compliance inspectors, law enforcement officers and any other party that deems the unit unclean and infested and will hold White Wings Living harmless for bed bug, roach or other pest infestations.

D. COOPERATION. If we confirm the presence or infestation of bed bugs or other bugs or rodents, you must cooperate and coordinate with us and our pest control agents AT YOUR EXPENSE. You must follow all directions from us or our agents to clean and treat the dwelling that is infested. You must remove or destroy personal property that cannot be treated or cleaned as close as possible to the time the dwelling is treated. We have the right to require you to temporarily vacate the dwelling and remove all furniture, clothing and personal belongings in order for us to perform pest control AT YOUR EXPENSE. If you fail to cooperate with us, you will be in default and we will have the right to terminate your right of occupancy and exercise all rights and remedies under the lease contract. YOU ALSO AGREE TO ALLOW US TO EXTERMINATE THESE PESTS IMMEDIATELY UPON DETERMINATION THAT INFESTATION HAS OCURRED AND THAT YOU WILL REIMBURSE US FOR THIS EXTERMINATION.

RESPONSIBILITIES OF LICENSEE, LICENSEE’S REPRESENTATIVE AND/OR LEGAL REPRESENTATIVE

A. You, your representative and/or legal representative, to the extent specified in this agreement, are responsible for the following:

1. Payment of the monthly fees

2. Supply of personal clothing, activities of daily living, medicine, medicine management and other

normal day-to-day items and tasks including but not limited to doctor visits, transportation, case management and social worker appointment meetings and scheduling’s.

PROPERTY MAINTENANCE

A. Licensee’s General Responsibilities: Licensee, at Licensee’s expense, must:

(1) Keep the Property clean and sanitary;

(2) Promptly dispose of all garbage in appropriate receptacles;

(3) Take action to promptly eliminate any dangerous condition on the Property and/or room;

(4) Certify that they will perform all activities of daily living without the help or assistance of any White Wings Living representative such as showering, taking medications, shaving, cutting and preparing food, toileting, transportation, dressing and any other activity performed on a daily basis.

(5) Certify that they have inspected their room and that the room is clean and well-maintained.

(6) Adhere to fire safety protocols

INDEMNIFICATION

The Licensee hereby agrees to indemnify, defend, and hold harmless White Wings Living, its agents, owners, staff, directors, officers, affiliates, successors, and assigns (collectively referred to as "White Wings Living Parties") against any and all claims, liabilities, losses, damages, costs, or expenses (including reasonable attorney’s fees) arising out of or related to:

1) Bodily injury (including death) or property damage caused by any act or omission of the Licensee, or the Licensee’s family, guests, agents, or invitees;

2) Any violation of laws, rules, or regulations by the Licensee, or the Licensee’s family, guests, agents, or invitees;

3) Use or misuse of White Wings Living property, including but not limited to pools, trampolines, recreational facilities, or any common areas;

4) The Licensee’s failure to perform any obligation under this Agreement, including but not limited to failure to vacate the premises upon termination.

Licensee expressly waives and releases all claims against White Wings Living Parties for any damage, injury, or loss to persons or property arising from Licensee’s use of the premises or participation in activities on the property, except to the extent caused solely by the gross negligence or willful misconduct of White Wings Living Parties. This waiver includes claims arising from natural disasters, acts of God, theft, vandalism, fire, water damage, or other causes beyond White Wings Living’s control.

White Wings Living, its agents, and its representatives shall not be liable for any damage or loss to persons or property caused by other licensees, guests, or third parties. Licensee further acknowledges and agrees that failure or delay in enforcing the covenants of other licensees shall not constitute negligence, fault, or misconduct by White Wings Living Parties.

The Licensee assumes all risks associated with their occupancy and use of White Wings Living facilities, including but not limited to participation in recreational activities or use of common areas. Security cameras are in place to monitor the property for safety purposes; Licensee agrees not to tamper with such equipment and understands that recordings may be used for security purposes only.

The provisions of this indemnification are solely for the benefit of White Wings Living Parties and do not create any rights or remedies for third parties. The Licensee’s obligations under this section shall survive the termination of this Agreement.

By signing below, the Licensee acknowledges and accepts the terms of this Indemnification section as a material and binding part of this Agreement.

Applicant Signature*

Date signed:*

First Name*

Last Name*

GENERAL RULES

Instructions:

Certify that you agree to the below items by clicking the check box.

Untitled*

I am aware that the move-in fee is non-refundable under any and all circumstances. My payment (in full) is due by no later than the fifth (5th) of each month via a third party representative payee or credit card, or agreed upon app.

Untitled*

I understand that upon leaving a White Wings Living location by my will or as a result from rule infractions I will not be eligible for a refund.

Notice Requirements for Vacating Premises

Licensees must provide at least 30 days’ written notice to the House Leader or Manager prior to vacating. Failure to provide notice will result in White Wings Living seeking recovery of actual damages incurred, such as costs associated with preparing the room for a new occupant.

Termination of Agreement

Management retains the right to terminate this license agreement for significant violations of house rules, including physical violence, substance abuse, or damage to property. For minor violations, licensees will receive notice and an opportunity to cure before termination. White Wings Living reserves the right to terminate immediately for serious violations explicitly outlined in Addendum VIII.

Relocation Provisions

White Wings Living may relocate a licensee temporarily or permanently for maintenance, safety, or operational reasons. Relocation costs incurred by the licensee must be preapproved, reasonable, and explicitly defined in this agreement.

Behavioral Standards

Licensees are expected to adhere to all house rules outlined in Addendum VIII. Violations may result in dismissal from the property and actionable remedies for damages caused.

Untitled*

I understand that this agreement is not a lease. License holder may give a minimum of 30 day notice to vacate. Any damages by licensee will be the financial responsibility of the licensee. Management may terminate this agreement for significant violations of house rules, including, but not limited to: use of physical violence, substance abuse, failure to pay the agreed upon licensing fee, or property damage. Licensees will receive written notice of minor breaches and an opportunity to cure before termination. Immediate termination may occur only for serious, detrimental behaviors clearly specified in this agreement. . . Upon termination, the licensee must vacate the premises immediately.

Untitled*

For the purposes of this agreement, 'vacating the premises' means the licensee and all of the licensee's personal belongings have been fully removed from the property, with no intent to return.

Untitled*

I understand that some of the food used is sourced from the community (for example, local food banks). Licensees are expected to participate in these resources.

Untitled*

White Wings Living may relocate a licensee temporarily or permanently for maintenance, safety, or operational reasons.

Miscellaneous Provisions

Choice of Law:

This Agreement shall be governed by and construed in accordance with the laws of the State of Oklahoma, without regard to its conflict of laws principles.

Venue:

Any legal action or proceeding arising out of or related to this Agreement shall be brought exclusively in the courts located in Oklahoma County, Oklahoma, unless the parties mutually agree to an alternative venue.

Attorney’s Fees:

In any legal action or arbitration arising out of this Agreement, the prevailing party shall be entitled to recover its reasonable attorney’s fees, costs, and expenses, in addition to any other relief granted.

Alternative Dispute Resolution (ADR):

Any dispute, controversy, or claim arising out of or relating to this Agreement, including its breach, shall first be submitted to mediation. If the dispute is not resolved through mediation, it shall be resolved by binding arbitration in accordance with the rules of the American Arbitration Association. The arbitration shall take place in Oklahoma City, Oklahoma, Oklahoma, unless both parties agree to a different location. The arbitrator’s decision shall be final and binding.

Force Majeure:

Neither party shall be liable for failure to perform any obligation under this Agreement due to events beyond their reasonable control, including but not limited to acts of God, natural disasters, pandemics, or governmental actions.

Entire Agreement:

This Agreement constitutes the entire understanding between the parties with respect to its subject matter and supersedes all prior agreements, representations, or understandings, whether written or oral.

Severability:

If any provision of this Agreement is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Modification:

This Agreement may only be amended or modified in writing, signed by both parties.

Notice Requirements:

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses provided in the Agreement or via email with confirmation of receipt.

By signing below, the Licensee acknowledges and accepts the terms of this General Rules section as a material and binding part of this Agreement. The Licensee personally guarantees payment of charges for the daily/monthly fees.

Applicant Signature*

Date signed:*

First Name*

Last Name*

Addendum VIII: House Rules

Violation of the following rules may result in termination of your stay. Residents are allowed up to three warnings for non-critical violations. Violations highlighted in red will result in immediate removal from the home.

Untitled*

I understand the above

1) SAFETY:

a) No loitering or hanging out in the front yard for any reason. The back patio is used for this.

b) Keep entry and exit doors closed and locked at all times

c) No weapons, drugs, or paraphernalia of any kind

d) Do not leave items on the floor that may cause a slipping or trip hazard

e) If you spill anything on the floor immediately wipe it up and the place a wet floor sign

f) In case of an emergency, we need all residents to sign in and out of the home when leaving the property.

2) GENERAL:

a) Do not steal or use another person’s items without permission.

b) Do not open or enter any cabinets or closets with locks

c) Turn lights off when not in use

d) You may NOT enter another resident's room at any time

e) Keep room door closed at all times

f) Clothes must be worn outside of your room.

g) Never leave personal items unattended in common areas of the home

h) Kitchen closes at 8pm

i) Residents can enter the home during these hours ONLY:

6AM-11PM Sunday – Thursday, 12am TV off

6AM – 12AM Friday and Saturday, 12am TV off

24 hour prior written notice must be given for any & all exception

j) If you are diabetic or need to give yourself shots using a syringe, you will need to have a medical grade bin to dispose of used needles properly.

3) SMOKING, ALCOHOL, AND DRUGS:

a) Smoking on backyard patio ONLY

b) No Alcohol consumption or storage of alcohol in or around premises

c) Do not share medication

d) No storage or use of illegal drugs or unprescribed medication allowed

e) Residents are required to submit to a drug and alcohol test at any time as per request. A refusal and/or failure to

provide an adequate sample will be treated the same as a positive test result. Any attempt to cheat/circumvent a test will result in a dismissal.

4) CLEANLINESS:

a)put trash in the trash can, put dirty dishes in the sink, clean up after you use the bathroom

b) Your room shall be kept in an orderly and sanitary condition at ALL times

c) Food is only to be consumed in the kitchen.

d) Food is NOT ALLOWED in bedrooms at any time.

e)If you spill anything or make a mess anywhere in the house including your room you will be responsible for cleaning it up.

5) YOUR ROOM:

a) You may NOT enter another resident's room at any time

b) Mattress covers must NEVER be removed

c) Keep room door closed at all times (No Personal Locks )

d) Keep personal items inside of your room (Valuable items should be secured)

e) All rooms are subject to search by White Wings Living staff

6) PERSONAL HYGIENE

a) Diapers, bed pads, or any personal hygiene items must be disposed of properly.

b) You shall keep up with your personal hygiene by bathing and brushing your teeth frequently.

c) You shall have no complaints that you or your personal space has offensive odors.

7) BEHAVIOR:

a) No aggressive or violent behavior EVER!

b) No profanity or offensive language directed at any residents, neighbors, or Anchor staff or helpers

c) No lending or borrowing money, cars or other property from other residents or neighbor

d) All residents must attend outpatient treatment

e) No romantic advances on White Wings Living staff

8) LAUNDRY:

a) Use of Laundry on scheduled day and time ONLY

b) Laundry area must be clean

c) You may not wash another person’s clothes

d) You may not put feces soiled items into any washer or dryer in the home

Untitled*

My signature signifies, I have read and understand what I can and cannot do while living in White Wings Living. I understand and agree that if I break any rules within this document in red type, my stay will be terminated immediately, and I will be banned from living in other homes that White Wings Living manages.

Applicant Signature:*

Date signed:*

First name*

Last Name*

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EMERGENCY CONTACTS

EMPLOYMENT INFORMATION

TREATMENT INFORMATION

TREATMENT INFORMATION

LICENSE AGREEMENT

FEES

Monthly Fee of $640

PEST CONTROL AND INFESTATION

RESPONSIBILITIES OF LICENSEE, LICENSEE’S REPRESENTATIVE AND/OR LEGAL REPRESENTATIVE

PROPERTY MAINTENANCE

INDEMNIFICATION

GENERAL RULES

Notice Requirements for Vacating Premises

Termination of Agreement

Relocation Provisions

Behavioral Standards

Miscellaneous Provisions

Choice of Law:

Venue:

Attorney’s Fees:

Alternative Dispute Resolution (ADR):

Force Majeure:

Entire Agreement:

Severability:

Modification:

Notice Requirements:

Addendum VIII: House Rules

Violation of the following rules may result in termination of your stay. Residents are allowed up to three warnings for non-critical violations. Violations highlighted in red will result in immediate removal from the home.

1) SAFETY:

2) GENERAL:

3) SMOKING, ALCOHOL, AND DRUGS:

4) CLEANLINESS:

5) YOUR ROOM:

6) PERSONAL HYGIENE

7) BEHAVIOR:

8) LAUNDRY:

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