Caregiver Service Agreement Instructions:
Opening Paragraph – First enter the date that this Agreement is being entered into. Then enter the name of the Recipient. The Recipient is the person who is receiving the care. On the third blank line enter the name of the Caregiver. The Caregiver is the person providing the care.
Background Section- Paragraph I: enter the location where the Caregiver will provide the care and services.
Terms Section:
Paragraph 1 –Term: Enter the date that the Caregiver will start to provide the services.
Paragraph 2– Services to be Provided: Enter the Services that the Caregiver will be providing. Some examples of services may include, but are not limited to assisting the Recipient with their daily activities of everyday living, scheduling medication, preparing meals, giving the Recipient the meal, running errands, transportation, light housework, and provide any other caregiving services as necessary.
Paragraph 3– Schedule: Enter the schedule of days and times that the Caregiver will be providing its services. For example, Monday through Friday from 10 am until 6 pm.
Paragraph 5 – Compensation: Enter the compensation that the Caregiver will receive here. Enter the amount and then state if its per hour, per week, per month, per year, etc.…. For example, The Recipient will pay the Caregiver $75 per week.
Paragraph 6 – Room and Board: Here check off the appropriate box that applies to your situation. In the first option, select if the Recipient will or will not provide room and board by circling your selection.
Paragraph 7 – Reimbursement: Here select by circling will or will not reimburse for out-of-pocket expenses. If there is a vehicle, state if rate of reimbursement for the mileage, if you are not reimbursing for mileage, enter zero 0.
Paragraph 8 – Employment Status: Check off the appropriate box as to whether the caregiver is an independent contractor or an employee. Read each section to see which applies, if you are unsure it is best to speak with your accountant.
Paragraph 11 – Governing Law: Enter the State that the Recipient resides in and will be receiving care in as the state that the laws will govern here.
Paragraph 1 5– Additional Terms: If you have any additional terms that are not included and you would like to add here, enter it here. Make sure to use clear and concise sentences and refer to each party correctly, the Caregiver is the one providing the services and the Recipient is the one receiving the care.
Signature Section: Enter the date that you are entering into this agreement, its is the same date as above. Enter it as day, month year. For example, on this 5th day of August, 2022.
The Caregiver and Recipient should then sign. It is also a good idea to have the signatures notarized. The notary acknowledgement is provided on the next page.