An agreement for a non-medical caregiver providing in-home support to a senior — scope of care, schedule, and emergency contacts.
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汎用的な無料テンプレートであり、法的助言ではありません。プレースホルダーに入力し、利用前に弁護士によるレビューをご検討ください。
This Senior / Elder Care Services Agreement ("Agreement") is entered into as of [Effective Date] between [Family/Client Name] ("Client") and [Caregiver Name] ("Caregiver"), for the care of [Care Recipient Name].
Caregiver will provide non-medical support services, including: [Services — e.g. companionship, meal preparation, light housekeeping, medication reminders, transportation]. This Agreement does not cover skilled nursing or medical care.
Caregiver’s schedule is [Schedule], at [Location].
Client agrees to pay Caregiver [Rate] per hour, paid [Frequency].
In case of emergency, Caregiver will contact [Emergency Contact Name/Phone] and, if needed, call 911. Relevant medical conditions, medications, and physician contact are described in [Attachment].
Caregiver agrees to keep the Care Recipient’s health and personal information confidential, sharing it only with those authorized in this Agreement or by Client.
Caregiver is an independent contractor, not an employee of Client, and is responsible for their own taxes, insurance, and any required certifications.
Either party may terminate this Agreement with [Number] days’ written notice, or immediately in the case of a safety concern.
This Agreement is governed by the laws of the State of [State / Jurisdiction].
Caregiver Signature: _______________________ Date: _______________
Client Signature: _______________________ Date: _______________