Client Liability Exclusion
Because I wish to maintain and exercise a certain degree of independence while living in(at) the following address: ______a personal care home, I, ______(client), agree that the provider, Favored Healthcare Services, will not be held responsible for anything that may happen to me or my vehicle if I leave the premises in my own vehicle or on my own power (walking, with friends, etc.).
I also understand and agree that I will always make the provider aware of where I am going and when I will return. Failure to do so may result in the immediate termination of services from the provider, without the required thirty (30) day notice, of my admission agreement with this personal care home.
Client: Date: ______
Witnessed: Date: ______
Provider: ______Date: ______
052607