Land Manor Privilege Card Application
If you plan to sponosor a client, or other outside activity, are you willing to transporat client(s) in your personal vehicle?
If you answered Yes to driving, please upload a current copy of your vehicle insurance.
Have you ever been convicted of a felony (excluding misdemeanors)? Many individuals in recovery have a past, and a felony conviction does not automatically disqualify you from becoming a PC Holder. If yes, you will be asked to provide additional information.
Please List the Charge, Location & Date of Last Felony Conviction, if applicable?
By checking each box, I agree to adhere to the following Privilege Card Holder rules, at all times:
Maintain current contact information (including phone number) with Land Manor at all times.*
Keep current insurance and vehicle registration on file and updated as needed.*
Obey all laws, including traffic laws, when transporting any Land Manor client.*
Support client recovery at all times. Do not encourage or allow any violation of Land Manor rules, policies, or procedures. Promote healthy, recovery-focused choices both on and off grounds.*
Follow all approved pass limitations exactly. Contact Land Manor immediately if any change or issue arises.*
Assume full responsibility for any client while off grounds until they are safely returned and signed in.*
Immediately notify Land Manor if a client deviates from the approved plan or absconds.*
Never provide or allow access to drugs (illegal or prescription) or alcohol.*
Never engage in or allow any form of sexual conduct with a client.*
Conduct yourself at all times as a responsible, professional example of leadership and accountability.*
Comply with all Land Manor policies and all applicable Texas Health and Human Services Commission regulations.*
Do not transport any unauthorized individuals while a client is in your care.*
Do not leave a client unattended at any time unless explicitly authorized.*
Maintain appropriate boundaries at all times; relationships must remain non-exploitative and recovery-focused.*
Immediately report any safety concerns, incidents, or emergencies to Land Manor.*
Land Manor will run a background check on all Privilege Card applicants.*
PC Card Holder Acknowledgement
By signing below, I acknowledge that:
I have read and understand all Land Manor Privilege Card Holder rules and expectations.
I agree to comply with all Land Manor policies and procedures at all times.
I understand that failure to follow these rules may result in immediate revocation of my Privilege Card and possible restriction of future access.
