6. Assistance outside the Home. Caregiver shall run daily errands for______. These may
include but are not limited to, picking up dry cleaning, grocery shopping, shopping for
necessities and, if applicable, maintaining ___’s car.
7. Personal Care Needs. Caregiver shall observe ______’s physical and mental states on a
regular basis, and shall make arrangements, as necessary, to meet health needs by
arranging transportation to the physician of _______’s choice. Caregiver shall provide
assistance to ________ in carrying out the instructions of physicians including storing,
distributing and reminding ______ to take prescribing medications.
Caregiver shall also provide _______ with personal assistance with bathing, dressing,
toileting, hair care, shaving, eating, care of clothing, personal shopping and incidental
services, as needed.
8. Transportation. Caregiver shall assist with transportation needs by arranging for public
transportation or help with specially provided elderly transportation.
9. Companionship and Entertainment. Caregiver shall provide companionship and support
for ______.
10. Compensation. ______________ shall pay Caregiver:
___________ Weekly ___________ Monthly
On each ___ of the week/month $________ per hour.
11. Governing Law, Entirety of Agreement and Severability. This agreement shall be governed
by the laws of state of ______. It constitutes the entire agreement between the parties
regarding its subject matter. If any provision in this contract is held by any court to be
invalid, void or unenforceable, the remaining provisions shall nevertheless continue in full
force and effect.
THIS IS A LEGALLY BINDING CONTRACT. EACH PARTY HAS READ THE ABOVE AGREEMENT BEFORE
SIGNING IT. EACH PARTY UNDERSTANDS THE AGREEMENT THAT HE OR SHE IS MAKING.
We, __________ and Caregiver having read this agreement, agree to its terms and sign it as our free act
on the ____ Day of __________, _________.
__________________________________ _______________________________
[name of older adult] Caregiver
Witness
_______________________________ ___________________________________
Signature Address