Dogwood Valley Booking | Apply for Program Placement

Applicant Information

Full Name *

Date of Birth *

Phone Number *

Email Address

Current Living Situation *

Unsheltered (streets) In a shelter Staying with friends/family Other

Emergency Contact Name *

Relationship *

Emergency Contact Phone *

Background Information

Do you have any experience with farm work or homesteading?

Yes No

Are you interested in learning about homesteading and agriculture?

Yes No

Do you have any allergies, medical conditions, or physical limitations? (Disabilities will not prevent acceptance)

Yes No

Do you have a current State-issued ID?

Yes No

Do you have a current, active driver’s license?

Yes No

Do you have minor children living with you?

Yes No

Do you have pets living with you?

Yes No

Are you seeking shelter related to Domestic Violence?

Yes No

Are you a refugee from outside the United States?

Yes No

Do you have a history of substance abuse?

Yes No

If yes, are you currently in recovery?

Yes No

Are you currently on probation or parole?

Yes No

What are your short-term goals while in the program?

What are your long-term goals after leaving the program?

Financial Information

We WILL NOT DENY ANYONE SERVICES BASED SOLELY ON THEIR FINANCIAL STATUS. Those generating income are required to contribute 30% to the program.

Do you have any current sources of income?

Yes No

Gross Monthly Income ($)

Net Monthly Income ($)

Are you able to contribute financially to your stay in any way?

Yes No

If no, program participation/work on the homestead or through the STEP Group will serve as a contribution.

Program Agreement

By applying to Dogwood Valley by Rock Bottom Farms, I acknowledge and agree to the following terms:

I will maintain a drug- and alcohol-free lifestyle while in the program. I agree to drug and alcohol testing at the program manager’s discretion.
I will participate in all required program activities, including farm/homestead work, groups, skill-building sessions, work crew, and the STEP Group, as the program manager directs.
I will contribute to the community through work assignments and cooperative living.
I will follow all house rules and respect fellow residents and staff.
I will comply with all state and federal laws while involved in or on program property.
I will NOT have guests at the property without the written consent of the program manager.
I will contain my pets at all times, care for them, and clean up after them.
I understand that this is a working semi-off-grid farmstead with animals, crops, outhouses, wood-fired water heater, bugs, snakes, frogs, lizards, and other wildlife. The nearest gas station is one mile away.
I will respect others, their space, and quarters. I will not go into others’ spaces or access things that do not belong to me.
I will NOT take video or photos of others or the facility except as directed by staff. I will NOT post information online, including photos or the location of facilities. I will NOT post any information online that is detrimental to the program, its staff, or participants.
I agree that all mail or packages will be accepted via the program’s approved channels and not at the facility directly.
I agree that I am NOT a tenant but a client in the programs listed above. My housing and access to the property are dependent on my continued positive participation in the programs. Should I be terminated from the programs, I agree to leave the property and facilities promptly.
I understand that any violations of the above may result in immediate dismissal from the program and/or legal consequences.

Applicant Signature (type full name) *

Date Signed *

Contact & Submission

Preferred contact method

Additional notes or questions for our team

Dogwood Valley by Rock Bottom Farms

Applicant Information

Background Information

Financial Information

Program Agreement

Contact & Submission

Find Hope, Healing, and a place to Grow from the Rock Bottom up.