Hotel Adult Care Service Request

Please complete with only guests contact phone number and guests email address.

Please do not fill out with the hotel's contact information.

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Please Note: *Return car transportation is to be provided by client.

The Caregiver is PROHIBITED from taking the above adult(s) outside of the Guest’s hotel room and from taking the above Adult/Elder to the hotel pool without prior consent from the Guest. By signing below, Guest indicates that s/he is giving express permission for the Caregiver to take the above to the following locations:

The Guest gives permission to the Caregiver to take photographs and/or videos for the limited purpose(s) communicated between the Guest and Caregiver.

Travel Care Information

Upon completing the request for service form, FCO will confirm the request for service, email the confirmation with profile attached and charge the credit card provided.  Please note: There are no refunds for cancellations received less than 24 hours prior to the start time of the confirmed services.

Billing:

The rate of service is determined and provided to the client directly upon receiving the request for service. All services are billed in hourly increments, kindly be advised there is a 5-hour minimum charge for all adult care service requests. Upon confirming the care scheduled in this said confirmation, the services will be charged to the credit card provided according to the schedule stated in the email confirmation to follow. In the event the client and/or guest has additional services rendered past the said schedule confirmed, the client and/or guest will be billed a second charge to the original charge.

Please Note: Family Care Options holds the right to change the confirmed staff and/ or sitter and/or caregiver without notice in the event Family Care Options receives good information such as but not limited to the current health status of the confirmed staff personnel in which case, Family Care Options will make the necessary change of staff in the best interest of the client according to the original request.

Cancellation Policy: There are no refunds after services are confirmed. The credit card provided will be billed for the dates and times confirmed. All hourly rates and transportation will be charged to the credit card provided when the order is confirmed. If services are canceled, the client and/or guest is eligible for a credit for future services.

Transportation Policy: Client is responsible for return car transportation after 9:00 pm.

Please note: Upon submitting this request for service form Family Care Options will confirm the request and email you a confirmation and charge your credit card.Submitting this request for service form it’s considered an order form. For information about our rates and policies, please contact our office before submitting this request.

By signing below, I agree and understand the terms, billing and policy stated above.

By filling out and signing this credit card authorization form:

I hereby authorize Family Care Options, Inc. to charge the Credit Card provided for any and all services rendered and/or ordered by Family Care Options staff. The credit card provided will be charged in such a manner as if I were paying in person and signing a transaction slip. I understand there will be a 4% service fee for all telephone and internet credit card orders.