Highpoint Intake Form Pt 3

The form filler needs to input the email address

Names of previous Halfway Houses 过去住过的中途之家

Criminal & Drug Legal History 刑事与毒品历史

Rehabilitation Centre and Prison Record 监狱服刑及改造中心记录

Urine Test Supervision Police Station 验尿警署


Under Supervision 受监狱的监督


Assessment 评论:

Annex C
I declare that the information provided to the staff of Highpoint Halfway House during the interview session is true to my best knowledge. In situations where it is shown that I had not been truthful, I will be subjected to a reassessment of my stay. Highpoint Halfway House reserves the right to discharge me after the reassessment if I am found to be unsuitable for the program.
Limitations of Confidentiality:
I have been explained and understand that any information and/or any form of disclosure made with the staff of Highpoint Halfway House would be kept confidential.
However, I agree that Highpoint can disclose to other professionals and/or the public authorities (including Singapore Prisons Service and the Yellow Ribbon Singapore) access to such information for any of the following purposes:
i. Referral to any agency/organisation for the purpose of any form of intervention and assistance to meet my rehabilitation and reintegration needs;
ii. To prevent severe and imminent danger to myself, other individuals and/or society;
iii. To report any form of illegal act(s); and
iv. Where required by law.
I, hereby acknowledge that I have been briefed about the shelter programme and the house rules. I agree to abide by the rules of Highpoint Halfway House.