This form is a sample of an agreement between an elderly or disabled client and a Caregiver who operates as an independent contractor and provides personnel to assist Client to live at home and to have as much control over the home environment and life as possible under the circumstances. Caregiver's personnel also assist Client with the activities of daily living, scheduling medication, assistance with mobility, accompanying Client on errands and appointments, and such other services as agreed between Client and Caregiver.
In this agreement, Client waives damages for simple negligence of Caregiver, but not gross negligence or misconduct that is intentional or criminal in nature. Courts generally will not enforce waivers of this type of misconduct since such a waiver would be deemed to be against public policy because it would encourage dangerous and illegal behavior.
Caregiver Form Template With Signature In Suffolk
Category:
State:
Multi-State
County:
Suffolk
Control #:
US-00458BG
Format:
Word;
Rich Text
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You can complete an electronic Financial Declaration Form (EAF1) using our Suffolk Adult Care Portal. Therapists can print out a pre-filled signature log with Child's information.I,. attest that I am in need of immediate Personal Care Services. (Name) or Consumer Directed Personal Assistance Services. If you are a Suffolk Foster Carer you can receive £500 each time you help us to recruit more fostering households. Please read before completing the Parent Authorisation Form (PAF). View the Suffolk County SCAT Paratransit Application Form in our collection of PDFs. Sign, print, and download this PDF at PrintFriendly. All applications for postponements MUST BE MADE PRIOR TO YOUR DATE OF SERVICE. This form is available in the VaCMS.