Drop-in Intake Form and Agreement


Drop-in Agreement

House Practices and Rules

To ensure your safety and comfort, our youth have established a set of Practices that act as guidelines for appropriate behavior and conduct in the drop-in space. The Practices are a living document and change as our youth see fit. All new youth will receive a copy of the Practices. However, there are a few rules that are set by the staff. The rules are as follows:

- Out Youth is a drug-free, alcohol-free, tobacco-free, and weapon-free zone. You may not attend drop-in or our events while under the influence of drugs or alcohol, use tobacco products or vapes, or bring weapons to Out Youth or our events.

- If you leave the premises during drop-in, you are not permitted to return that evening. Leaving the premises is final.

- You must tell a staff member, intern, or volunteer when you are leaving.

Violation of the norms or rules may result in dismissal from Out Youth and our events.



The information you have provided on this form is confidential and will only be used by Out Youth staff in order to meet your specific needs. Any information shared will be shared anonymously for funding or research purposes only. Anything you disclose to staff or volunteers during drop-in will remain confidential, however it is up to the discretion of the staff and volunteers to discuss this information with one another in order to provide you with the services and support you deserve. Staff will never share non-emergency information with external partners without your consent.


However, there are a few instances where we must break confidentiality.

In accordance with Texas Law, we are legally required to report:

  • If you have experienced/witnessed in the past or you are currently experiencing/witnessing any physical, sexual, or emotional abuse or neglect of yourself or someone else.

  • If you are currently experiencing thoughts of hurting yourself or others.

  • If you are 12 to 16 years old and tell us directly that you have been sexually active.


Grievance Process

Any person who believes they have been negatively impacted by an act or decision of Out Youth has the right to personally (or through a representative) submit a grievance by following the steps below.


Step 1: Submit a written statement to the Executive Director explaining the facts of your grievance. The Executive Director will then notify the Board of Directors of your grievance by sending them a copy of your written statement. The Executive Director will contact you within 15 days to schedule an informal meeting to discuss, and hopefully resolve, your grievance. The informal meeting must take place within 45 days of the Executive Director receiving your grievance.


Step 2: If your grievance is not resolved at the informal meeting, the Executive Director has up to 15 days to make a decision. If no decision is made or you do not agree with the decision made by the Executive Director, you can request a hearing by the Board of Directors by submitting a written request to the Executive Director.


Step 3: The Board of Directors has the authority to choose if they will hear the grievance. If they choose to hear the grievance, a special committee will be appointed. The hearing will take place at the next regularly scheduled meeting of the Board of Directors, or a special meeting may be scheduled for the purpose of hearing the grievance. The hearing must take place within 60 days of the Executive Director receiving the request for a hearing. The Board of Directors will require the Executive Director to participate in the discussion of the grievance. The Board of Directors will issue a written decision on the grievance within 15 days of the hearing. The decision of the Board of Directors will be final at the local level.


Grievance Against Director

If you want to file a grievance against the Executive Director, the same steps above apply with the exception that the Chair of the Board of Directors will serve as the liaison for the Grievance Process. During the Grievance Process, the Executive Director will recuse themselves from all administrative duties and the Chair of the Board of Directors will assume those responsibilities.



When discussing your complaint, you can have a representative come with you to the meetings. If you will be represented by legal counsel, you must inform the Executive Director 5 or more days in advance. If you do not inform the Executive Director 5 or more days in advance, Out Youth has the right to postpone the meeting or hearing for an additional 5 days.



All records of the Grievance Process, including written documentation of the discussion and decision of the Board of Directors, will be kept on file at Out Youth.


We Care About Your Safety

Please note Out Youth runs a drop-in center, not an emergency center. As a result, our phones and emails are not monitored 24/7. If you are considering hurting yourself or others, or are in an emergency situation, please call 911 or one of the other emergency services we’ve listed on the attached handout. We encourage you to add these phone numbers to your phones right now.

Our number one responsibility is to give you a safe and nurturing place to live authentically, build community, and have some fun. If there is anyway we could provide this service more effectively to you, please don’t hesitate to let us know!