Register – California Room & Board Coalition

This is a free trial membership. You will not be charged during the trial period, and renewal is not automatic. We’ll notify you when paid membership options become available.

California Room & Board Coalition©
Member Application Package
Coalition Membership demonstrates your willingness to maintain housing that is healthy, safe, well- managed, and provides an environment conducive to the wellness and recovery of hospital or Behavioral Health consumers and others. Once you have met all of the membership requirements, your facility will be evaluated, then placed on the California Room & Board Coalition© subscriber database to be used as a resource by hospitals, socials workers, Behavioral Health Providers and other interested parties. Please provide requested information.
CONFLICT OF INTEREST DISCLOSURE STATEMENT
The purpose of this disclosure statement is to identify, address, and resolve any employment, activity or enterprise that may be inconsistent, incompatible, or in conflict with the duties of a Room & Board Operator associated with the California Room & Board Coalition©.
Coalition Member Name*
Position
Facility Name*
Facility Address:
Address line 1*
Address line 2
City*
State*
Are you currently employed by (or contracted to provide services for) any California Behavioral Health Organization and/or Alcohol and Drug Program?*
Please Specify*
OPERATOR INFORMATION
Owner/Operator’s Name(s):
First Name*
Last Name*
Contact Information
On-site Manager’s Contact Information
Facility Name*
Facility Address*
Address line 2
City*
State*
Mailing Address
Address line 1
Address line 2
City
State
FACILITY INFORMATION
Type of Facility*
Specification*
Facilities
Do you have Kitchen?*
Specification for No.
Resident Capacity
Total Resident Capacity*
Accommodate*
- Male
- Female
- Co-ed
- Seniors
- LGBTQ
- Private
- Shared
- Families
- Children friendly
- Couples
- College Students
Select all populations your home accommodates.
Monthly Rental per Person*
What is your incident reporting process?*
What is your bed retention policy?*
Tenant Agreement*
What are the Progressive Disciplinary Actions?
First Offense*
Second Offense*
Third Offense*
Fourth Offense*
What are the Terms and Conditions for Eviction? ( FAQs )*
Deaf and Hard of Hearing / ADA Friendly
Is your accommodation ASL and ADA friendly?*
HOUSE AMENITIES AND RESPONSIBILITIES
Are residents assigned chores?
- Yes
- No
Are visitors allowed?*
- Yes
- No
What are the rules/policies regarding visitation?*
Is there a curfew?*
- Yes
- No
If yes, what time is the curfew?*
Are meals Included?*
- Yes
- No
How many meals per day?
Snacks included?
- Yes
- No
Is there a secured area available for personal property?*
- Yes
- No
Smoking allowed?*
- Yes
- No
If yes, where can residents smoke?*
Do residents have access to a telephone?*
- Yes
- No
Are there specific rules that govern the use of phones?*
- Yes
- No
What is the distance to the nearest public transportation?
Pet Friendly?*
- Yes
- No
Size / Kind / Number of Pets*
AMENITIES
Are linens and/or towels provided?*
- Yes
- No
Are toiletries provided? (Shampoo, conditioner, soap, etc.)*
- Yes
- No
Is toilet paper provided?*
- Yes
- No
Are washer and dryer available for resident use?*
Is it available at all times?*
Explain why*
Are laundry supplies provided?*
- Yes
- No
Do residents have access to common areas in the Room & Board (ex. living room, patio, pool, etc.)?*
What are the common area rules?*
Does each bed have a mattress and box spring encasement to prevent the infestation of bed bugs?*
- Yes
- No
HOUSE MANAGER INFO
Do you have a House Manager?*
Is the operator/house manager on premises at all times?*
First Name*
Last Name*
PHOTO RELEASE
RELEASE OF LIABILITY
(Insurance and Business License) As an active member of the California Room and Board Coalition, I understand that it is my responsibility as the owner/operator of the room and board facility indicated to provide evidence of licensing and/or general liability insurance that properly identifies the property use as recommended.
Website Profile
Username*
Password* Minimum length of 10 characters.
The password must have a minimum strength of StrongStrength indicator
Repeat Password*
First Name*
Last Name*
Picture Profile*Upload

(We recommend a photograph that includes the front of the house without any individuals in the frame).
E-mail*
Phone*
Is your home licensed or unlicensed?*
- Licensed
- Unlicensed
Subscription Plans
Yearly - $2,200 / 1 Year with a 3 months free trial
Sign up now to be listed as a room and board facility at no cost. Enjoy free access to CRBC's advocacy network, resources, and referrals. A paid subscription with added benefits will be introduced later- but your spot is secure when you join today.
6 Monthly - $1,650 / 6 Months with a 3 months free trial
Sign up now to be listed as a room and board facility at no cost. Enjoy free access to CRBC's advocacy network, resources, and referrals. A paid subscription with added benefits will be introduced later- but your spot is secure when you join today.
Month to Month - $275 / 1 Month with a 3 months free trial
Sign up now to be listed as a room and board facility at no cost. Enjoy free access to CRBC's advocacy network, resources, and referrals. A paid subscription with added benefits will be introduced later- but your spot is secure when you join today.

California Room & Board Coalition© Member Application Package

CONFLICT OF INTEREST DISCLOSURE STATEMENT

Facility Address:

OPERATOR INFORMATION

Owner/Operator’s Name(s):

Contact Information

On-site Manager’s Contact Information

FACILITY INFORMATION

Facilities

Resident Capacity

What are the Progressive Disciplinary Actions?

Deaf and Hard of Hearing / ADA Friendly

HOUSE AMENITIES AND RESPONSIBILITIES

AMENITIES

HOUSE MANAGER INFO

PHOTO RELEASE

RELEASE OF LIABILITY

Website Profile

(We recommend a photograph that includes the front of the house without any individuals in the frame).

Subscription Plans

California Room & Board Coalition©
Member Application Package