Resident Application Forms

As a part of the admission process to the Safe House all prospective Residents are required to fill out and application form and, read and sign the Program Rules Agreement form.

Upon application and interview approval, a mandatory background screening will be required.

The forms can be downloaded in the links at the bottom of this page. Completed forms can be sent to  Hepzibah House via: e-mail, fax or mail.

E-mail forms to:
info@hepzibahhouse.org
 
Fax forms to:
(866) 614-5055
 
Mail forms to:
Hepzibah House
1530 W Boynton Beach Blvd, #3863
Boynton Beach, FL 33424

 

CLICK HERE TO DOWNLOAD THE  CLIENT APPLICATION FORM

 

CLICK HERE TO DOWNLOAD THE PROGRAM RULES AGREEMENT FORM