Adult Care Time Sheet

Billing: By signing below, I understand and agree to the schedule and information stated and contained on this timesheet and the activity log of events transpired during the services rendered is true and accurate. The terms of payment will be billed to my credit card for the hourly rate of service quoted and stated in the confirmation of services received upon confirming the services. The form of payment provided will be billed for the services rendered and transportation stated in the confirmation and compiled for the final charges due based on this timesheet.

Liability: I, the parent and/or primary caregiver release Family Care Options and the independent contractor (Caregiver) stated on this time sheet of any and all causes of injury, damages losses, claims, suits or liability of the caregiver referred by Family Care Options, including but not limited to, claims that may arise out of , or, resulting from the acts, errors or omissions of Family Care Options and the independent contractor (Caregiver) of the above-referenced services rendered.

No Contact: I, the parent and/or primary caregiver, agree to exclusively contact Family Care Options for any and/all further services not stated on this timesheet. I understand it is against Family Care Options Policy to call, text or have any contact with the Family Care Options referred independent contractor (Caregiver) for any reason outside of a requested job and/or job stated above for any reason. If for any reason, I should take such such actions I will be held liable and legally responsible for any claims, loss of wages, damage to the company reputation, fees, and/or loss of monies due to Family Care Options that may occur from taking such actions.

Log of Events: I have read, understood and approved by signing the log of events that transpired and specified on this time sheet while providing care for the adult.